Disability due to restrictions in childhood epilepsy

Agreement in reporting restrictions in life between children with epilepsy and their parents

BACKGROUND

This study aimed to determine the parent-child agreement of the Hague Restrictions in Childhood Epilepsy Scale (HARCES) and identify the clinical factors associated with parent-child disagreement and the restrictions.

METHODS

Data come from a clinical sample of 90 children ages 9-17 (mean age = 12.9, SD = 6.9, 54% male) attending a pediatric neurology clinic. Parents completed the HARCES, and children completed a modified child-friendly scale (HARCES-M). The parent-child agreement was assessed using intraclass correlation coefficients (ICC) and paired t-tests to compare parent and child responses. Logistic regression examined clinical factors associated with disagreement > 0.5 standard deviation. Associations between clinical factors and restriction scores were examined using linear regression.

RESULTS

Parent-child agreement on the HARCES was poor (ICC = 0.36, 95% CI: 0.03, 0.58), and parents reported fewer restrictions in daily activities (t(89) = 2.45, p = .016) and to attend parties (t(89) = 2.12, p = .038); however, the overall restrictions scores were not different (t(89) = 1.55, p = .125). The presence of convulsive seizures (OR = 0.20, 95% CI: 0.05, 0.75) and longer duration of epilepsy (OR = 1.19, 95% CI: 1.01, 1.41) were associated with parent-child disagreement. No clinical factors were significantly related to either the HARCES or HARCES-M scores.

CONCLUSIONS

The disagreement in perceptions of restrictions highlights the need to use child-reported measures along with parental reports to comprehensively understand restrictions on children with epilepsy fully. More research is needed to understand what factors explain parent- and child-rated restrictions due to epilepsy.

Memory efficiency in patients with drug-resistant epilepsy

OBJECTIVE

To evaluate memory in patients with drug-resistant epilepsy.

METHODS

Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Wechsler Memory Scale. It assessed seven structural types of memory: general knowledge, orientation, mental control, logical memory, number memory, associative memory, and visual reproduction. The values were compared with 50 subjects without epilepsy.

RESULTS

Patients with epilepsy had statistically significantly lower values in five of seven structural units of memory. The average value of overall memory efficacy in subjects with epilepsy was 96.5 ± 19.6, while in subjects without epilepsy it was 118 ± 15.6 (p = 0.0002). Memory impairments are greater in those taking polytherapy (p = 0.0429). The overall memory efficiency correlated significantly negatively with seizure frequency (p = 0.0015) and insignificantly negative with the duration of epilepsy (p = 0.1935).

CONCLUSION

Patients with drug-resistant epilepsy have lower memory efficiency. Memory impairments are greater in those taking polytherapy, as with those with more frequent seizures. The duration of epilepsy has no significant effect on overall memory performance.

The impact of parenting stress on parents of school-age children with drug-resistant epilepsy

BACKGROUND

Psychological burdens can affect the quality of life among parents of children with epilepsy, especially parents of children with poor seizure control. The impact of stress on the parents of children with epilepsy is significantly comorbid with their children's cognitive dysfunction and the severity of epilepsy. The aim of this study was to assess the stress levels of parents of school-age children with drug-resistant epilepsy (DRE) and controlled-epilepsy after considering the children's cognitive ability.

METHODS

The study participants consisted of 35 children with typical development in the control group, 25 in the controlled-epilepsy group, 26 in the DRE group, and their parents. We used the Chinese version of the Parenting Stress Index (PSI) to measure the stress levels of all parents; and the Wechsler intelligence scale for children-fourth edition (WISC-IV) Chinese version to assess the children's cognition levels.

RESULTS

Parenting stress was significantly higher among the parents of children with DRE than of those in the control and controlled-epilepsy group. The PSI's child domain showed statistically significant subscales of adaptability, acceptability, demandingness, and distractibility/hyperactivity. Moreover, the high-risk ratio on the acceptability, adaptability, demandingness, and distractibility/hyperactivity subscales were also higher for the DRE group than for the controlled-epilepsy group and for the control group.

CONCLUSION

Seizure severity significantly influences parenting stress after considering cognitive dysfunction in children with epilepsy. Therefore, pediatricians and clinicians should consider epilepsy-specific stress in parents of children with DRE.

Inclusion and participation of children with epilepsy in schools: Views of young people, school staff and parents

OBJECTIVE

To gain an understanding of the views of children with epilepsy, their parents and staff regarding inclusion and participation of children with epilepsy in school.

METHODS

During the study period, 136 children with 'active' epilepsy (taking anti-seizure Medications (ASMs) for epilepsy), were identified in the study area and of these 68 (50% of those eligible) families agreed to participate. Children (n = 20) with 'active epilepsy' their parents (n = 68) and staff (n = 56) were interviewed or completed surveys. The quantitative data were analysed using descriptive statistics and chi-square analyses. The answers to open questions were analysed using thematic analyses.

RESULTS

Staff in mainstream schools were more concerned about the child's attendance than staff in special schools (p = 0.008).Parents and school staff cited a number of negative aspects of the child's attendance difficulties including social-emotional and academic aspects. The majority of parents and staff felt that young people with epilepsy were included in school to the same extent as peers. Parents were however, significantly less likely than staff to agree that children were included in all playground activities (p = 0.045). Parents of children in special schools were more likely to agree that their child was included in school than parents of children attending mainstream schools (p = 0.041). Thematic analysis revealed that parents felt that their child could be excluded in school due to staff decisions, child's own choice and peer led exclusion. The majority of children (64%) and parents (56%) agreed that the child with epilepsy was restricted from doing things their peers could do because of their epilepsy. While more than half of children with epilepsy (63%) reported that they had been bullied, most did not attribute this bullying to having epilepsy. Parents were more likely to agree that their child was bullied because of their epilepsy (p = 0.035) and non-epilepsy reasons than staff (p<0.001). Parents of children with epilepsy attending mainstream schools were more likely to agree that their child was bullied because of their epilepsy (p = 0.017) and non-epilepsy reasons (p = 0.026), compared to parents of children with epilepsy attending special schools.

CONCLUSIONS

School attendance difficulties for children with epilepsy can contribute to academic and social-emotional difficulties. Most parents and teachers feel that children with epilepsy are included in classroom activities to the same extent as peers. Children with epilepsy and their parents believe that they are more restricted in non-classroom activities compared with their peers. Difficulties with participation, friendships and bullying for children with epilepsy may be due to presence of other conditions as opposed to epilepsy per se. There is a need to increase understanding of the wide ranging impact of epilepsy on school life in order to enhance attendance and inclusion and to reduce bullying.

Parental report of quality of life in children with epilepsy: A Spanish/French comparison

BACKGROUND

Epilepsy is a chronic neurological condition that affects the quality of life (QoL) of patients and their families. In this study, we compare two sets of reports on QoL that were completed by two samples of parents whose children have epilepsy.

METHOD

Parents of children with various types of epilepsy from Spain (N = 196) and France (N = 219) completed the same QoL questionnaire. Medical variables were recorded from the referred specialist doctor for each patient.

RESULTS

The factors associated with parental reports on QoL were similar in both countries. Parents of children with nonidiopathic generalized or unclassified epilepsy reported poorer QoL and the highest proportion of learning and behavioral problems. However, the intensity of difficulties varied between the two samples.

CONCLUSIONS

This questionnaire made it possible to detect comorbidities and daily life difficulties in children with epilepsy and their families. The type of epilepsy had the same influence on Spanish and French families' ratings of QoL. Families shared the same comorbidities in terms of hyperactivity/attention/sociability problems. Nevertheless, the intensity of reported difficulties varied in both countries, possibly because of differences in cultural and educational environments. This aspect should be further explored in future research.

Epilepsy-specific patient-reported outcome measures of children's health-related quality of life: A systematic review of measurement properties

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.

Exploring the relationship between parent-child communication about epilepsy and psychosocial well-being

This study examined the relationship between parent-child communication and psychosocial well-being of 47 children living with epilepsy and 72 parents of children living with epilepsy. Open communication was associated with positive illness attitude, positive self-perception and greater health-related quality of life for children living with epilepsy; positive response to illness for parents; and more perceived social support and less need for epilepsy-related support for children living with epilepsy and parents. By contrast, closed communication was associated with poorer psychosocial well-being in children living with epilepsy and parents. Healthcare professionals should provide guidance for families living with childhood epilepsy on the importance of open communication in promoting greater psychosocial well-being.

Vagus nerve stimulation for 6- to 12-year-old children with refractory epilepsy: Impact on seizure frequency and parenting stress index

OBJECTIVES

Refractory epilepsy (RE) is frequently associated with neuropsychological impairment in children and may disrupt their social development. Vagus nerve stimulation (VNS) had been reported to have beneficial effects on behavioral outcomes. The aim of this study was to compare Parenting Stress Index (PSI) scores before and after VNS device implantation in children with RE, especially those who experienced seizure frequency reduction.

METHODS

We conducted a one-group pretest-posttest study in school age children with RE. Seizure frequency and PSI were recorded at 12months after VNS device implantation.

RESULTS

Treatment with VNS was significantly associated with reduced seizure frequency and parental stress as measured by PSI. Factors contributing to seizure frequency included idiopathic/cryptogenic etiology and neurobehavioral comorbidities. In children with reduced seizure frequency, statistically significant improvements in the child domain of the PSI on the subscales of mood and reinforces parent were found. In the parent domain, the scores for social isolation were reduced.

CONCLUSIONS

Treatment with VNS was significantly associated with reduced seizure frequency and improved PSI scores, especially within the child domain on the mood and reinforces parent subscales. These findings suggest that VNS reduced not only seizure frequency but also the psychological burden on children with RE.

Quality of life in Malaysian children with epilepsy

BACKGROUND

Children with epilepsy (CWE) are at risk of impaired quality of life (QOL), and achieving a good QOL is an important treatment goal among CWE. To date, there are no published multiethnic QOL studies in Asia. Our study aimed to: i) investigate the QOL of multiethnic CWE in Malaysia as reported by both the child and parent; ii) determine the level of agreement between child-self report and parent-proxy report QOL; and iii) explore potential correlates of sociodemographic, epilepsy characteristics, and family functioning with QOL in CWE.

METHODS

Cross-sectional study of all CWE aged 8-18years old with at least 6months' duration of epilepsy, minimum reading level of primary school education Year 1, and attending mainstream education. Quality of life was measured using the parent-proxy and child self-report of Quality of Life Measurement for Children with Epilepsy (CHEQOL-25) questionnaire. Total and subscale CHEQOL-25 scores were obtained. The levels of parent-child agreement were determined using intraclass correlation coefficients (ICC). Family functioning was assessed using the General functioning subscale (GF-12).

RESULTS

A total of 115 CWE and their parents participated in the study. In general, Malaysian parents rated children's total CHEQOL-25 scores poorer than the children themselves [mean total parent score: 68.56 (SD: 10.86); mean total child score: 71.82 (SD: 9.55)]. Agreement between child and parent on the CHEQOL-25 was poor to moderate (ICC ranged from 0.31-0.54), with greatest discordance in the epilepsy secrecy domain (ICC=0.31, p=0.026). Parent and child were more likely to agree on more external domains: intrapersonal/social (ICC=0.54, p<0.001) and interpersonal/emotional (ICC=0.50, p<0.001). Malay ethnicity, focal seizure and high seizure frequency (≥1 seizure per month) were associated with lower CHEQOL-25 scores. There was a significant but weak correlation between GF-12 and parent-proxy CHEQOL-25 Total Scores (r=-0.186, p=0.046).

CONCLUSION

Our results emphasize the importance to have the child's perspective of their QOL as the level of agreement between the parent and child reported scores were poor to moderate. Malaysian CWE of Malay ethnicity, those with focal seizures or high seizure frequency are at risk of poorer QOL.

Perceived need for restrictions on activity for children with epilepsy

BACKGROUND

Children and youth with epilepsy have long been subjected to excessive restrictions on extracurricular activities due to concerns over risk of injury. Over time physicians and medical regulatory associations have liberalized the advice given for people with epilepsy to promote independence, self-esteem and general health benefits of physical activity. Current evidence suggests that few restrictions are needed for children with epilepsy beyond water-related precautions and avoidance of very high-risk activities. However, more stringent restrictions on daily activities may be imposed by caregivers. This study was aimed at exploring current perceptions of parents regarding restrictions on activity for children with epilepsy and the child's perspective on restrictions related to the diagnosis.

METHODS

A self-administered questionnaire was offered to a sample of parent-child dyads of children/youth with epilepsy attending summer camp for children with epilepsy age 8-18years. A 10-item validated HARCES Parent Scale of Childhood Epilepsy was completed by the parent/guardian and a modified-HARCES completed by the child. The primary objective was to assess the degree of restrictions placed on children with epilepsy from the perspective of child and parent assessed independently. Agreement of perceived restrictions between parent-child dyads was also determined.

RESULTS

21 parent/guardian-child pairs were recruited with mean age of children/youth 12.7years (range 9-16years). Total HARCES scores for parents and guardians ranged from 11-26 (x=16.5; SD 4.9) while total scores for children with epilepsy similarly ranged from 10-25 (x=15.2; SD 4.9). There were no differences in total parent scores when analyzed by child's age (<13 or >13years), gender, age of seizure onset, seizure frequency or seizure type. Total HARCES scores showed no agreement between parent and child pairs with correlation of 0.2798 (95% CI -0.173-0.635).

CONCLUSIONS

Children and youth with epilepsy often face activity restrictions based on fear of perceived risk of injury. This small sample shows evidence that even more permissive parents and his/her children still feel limited by such restrictions. Parents and children do not perceive these restrictions in the same way despite similar education by physicians highlighting an important secondary role of epilepsy camps in targeting misperceptions and educating families on appropriate precautions.

Personality traits of children before and after epilepsy surgery

We studied how children with epilepsy (CWE) who are candidates for epilepsy surgery, perceive themselves with respect to overarching personality traits and whether the traits change after surgery. We explored influences of demographic and illness variables. A total of 23 CWE [mean age at inclusion 12.8 (sd 2.3); 12 girls] participated. Using the Dutch Personality Questionnaire Juniors (DPQ-J), we assessed 20 of the CWE shortly before epilepsy surgery and compared the results to those of 39 age- and gender-matched healthy controls. Furthermore, we obtained follow-up scores 6, 12 and 24 months after epilepsy surgery from the clinical group. CWE who were candidates for epilepsy surgery scored above average in inadequacy, perseverance, social inadequacy and recalcitrance, whereas healthy peers scored average. Over the two years' period after epilepsy surgery we found no changes, apart from a decrease of social inadequacy. Sporadic illness and demographic variables were related to some personality traits. However, neither post-surgical seizure freedom nor cessation of AEDs did noticeably change the self-evaluations of CWE. Asking CWE to evaluate their personality themselves may offer a shared basis for individually tailored behavior intervention in order to help them adapting to their ameliorated circumstances after surgery.

The impact of epilepsy on preschool children and their families

This study investigated the possible presence of sensory-motor developmental impairments in preschool children with epilepsy and explored epilepsy impact on their activities and quality of life and on the stress load of their family. Study participants were children aged 2-6years diagnosed with epilepsy without any other comorbidities (epi-only children). The instruments used for assessment included the Neurological, Sensory, Motor, Developmental Assessment (NSMDA) scale for sensory-motor development, the Impact of Childhood Neurologic Disability Scale (ICNDS), and the Impact of Pediatric Epilepsy Scale (IPES) for disease impact on disability and Quality of Life (QoL), as well as the Pediatric Outcomes Data Collection Instrument (PODCI) for functional health status, and the Parental Stress Scale (PSS) for the family stress load. Required data were obtained from direct testing or observation of children's activities and mother-supplied answers to questions. Eighty-two children were investigated. The NSMDA scores were in the normal development range 6-8. Significant moderate impact of the disease on disability and QoL was estimated with the ICNDS and IPES instruments. The PODCI scores were similar to healthy population levels except for the happiness dimension which was better for children with epilepsy. PSS were significantly above normal. The functional health and QoL of the children as well as their family stress were found to be positively correlated with increasing age. It is found that epilepsy does not degrade neuromotor development and functional health status of preschool epi-only children, though it has a significant impact on their neurological disability and QoL and the stress level of their families; this impact seems to decrease with age.

Cognitive and behavioral impact of the ketogenic diet in children and adolescents with refractory epilepsy: A randomized controlled trial

PURPOSE

The ketogenic diet (KD) is increasingly used for the treatment of refractory epilepsy in childhood because of the beneficial effect on seizure reduction. The aim of the current study was to objectively assess cognition and aspects of behavior during the first 4months of a randomized controlled study in children and adolescents.

METHODS

Participants from a tertiary epilepsy center were randomized to a KD group (intervention) or a care-as-usual (CAU) group (control). Follow-up assessments on cognition and behavior were performed approximately 4months after initiation of the KD with a combination of parent report questionnaires and individually administered psychological tests for the children.

RESULTS

A total of 50 patients were enrolled in this study, 28 patients from the KD group and 22 patients from the CAU group. The KD group showed lower levels of anxious and mood-disturbed behavior and was rated as more productive. Cognitive test results showed an improvement of activation in the KD group.

CONCLUSIONS

This study showed a positive impact of the KD on behavioral and cognitive functioning in children and adolescents with refractory epilepsy. More specifically, an activated mood and cognitive activation were observed in patients treated with the KD.

Extracurricular participation among children with epilepsy in Canada

INTRODUCTION

Participation in extracurricular activities creates opportunities for children to foster friendships, promote a sense of belonging, and improve physical and mental well-being. The objective of this study was to determine the relationship(s) of personal factors, seizure variables, and social supports with extracurricular participation in children with epilepsy (CWE).

METHODS

Baseline analysis of the QUALITÉ longitudinal study cohort of children aged 8-14 years (N=426) was conducted. Variables hypothesized to be related to the participation of CWE were classified using the International Classification of Functioning, Disability and Health according to body functions (presence of generalized tonic-clonic seizures in the past month, on/off AEDs, and seizure severity), environmental factors (perceived social support from parents and friends), and personal factors (sex, age, family structure, and family income). Analysis of variables related to extracurricular participation was conducted with regression modeling.

RESULTS

Personal factors of age, gender, and family structure as well as body function variables of generalized tonic-clonic seizures and seizure severity were found to be the most important to extracurricular participation based on how frequently they were included in the final models (16/16 and 13/16 times, respectively). When parental support was found to be related to participation, the association was negative in 6 out of 16 models.

DISCUSSION

The personal factors that are related to extracurricular participation among children with epilepsy mirror samples based on the general population, although seizures also play an important role. The relationship between perceived parental support and actual participation levels warrants further exploration.

Seizure-Precipitating Factors in Relation to medical Recommendations: Especially Those Limiting Physical Activity

Identification of factors precipitating epileptic seizures should always have practical implications and should always result in special recommendations given to patients. The purpose of our study is to analyze the relation between seizure-triggering factors and restrictive recommendations involving limitation of physical activity in particular. The research group consisted of 407 children hospitalized due to seizures. Their precipitants were identified in 27.5% of the patients. The most common included infection/fever, stress, and flashing lights. Although sport was documented as a precipitant in only 3.4% of all children, 8.1% of the investigated group were recommended to limit physical activity. As some episodes of epileptic seizures are reported to be provoked by sport, multiple restrictions are imposed on children. In the light of the worldwide academic literature and the present study, the recommendation of limiting sports activity is no longer supported.

Illness perceptions determine psychological distress and quality of life in youngsters with epilepsy

The aim of this cross-sectional study was to explore the extent to which gender, epilepsy severity, and self-regulation concepts (illness perceptions, autonomous treatment regulation, perceived autonomy support by parents) predict psychological distress and quality of life (QoL) in young patients with epilepsy. Structured interviews were conducted in 100 patients (Mage=13.9, SD=2.21, 41% girls), and data were analyzed by means of multiple hierarchical regression analyses. Seizures of most patients (91%) were well controlled by antiepileptics, 3% of the patients had infrequent seizures, and seizures in 6% were pharmacoresistant. At a multivariate level, it appeared that youngsters with epilepsy who expect that their disease will last for a long time, who believe that they have less personal control over their illness, and who expect the illness to have a high emotional impact reported higher levels of distress. In addition, a better QoL was reported by youngsters who believed that treatment did not control their illness and who thought that their epilepsy would not affect them emotionally. Findings indicate the importance of illness perceptions, and it is suggested that they should be targeted in future interventions in youngsters with epilepsy.

The Personal Impact of Epilepsy Scale (PIES)

OBJECTIVE

The impact of epilepsy is manifest by effects related to seizures and side effects of therapy and comorbidities such as depression. This report describes the development of a brief patient-reported outcome (PRO) instrument, the Personal Impact of Epilepsy Scale (PIES), to measure the influence of epilepsy overall and in each of these domains.

METHODS

Instrument development followed standard procedures and an FDA Guidance. People with epilepsy were surveyed with open-ended questions to derive major themes of their concerns, resulting in 4 key areas: seizures, side effects, comorbidities, and overall quality of life (QOL). A preliminary set of 152 questions was based on these themes and completed by 50 patients, age 42.7 (range: 21-71) years, concurrent with comparator instruments, including the NH Seizure Severity Scale (NHSSS), the Liverpool Adverse Events Profile (LAEP), the Quality of Life in Epilepsy (QOLIE-31) scale, the Beck Depression Inventory, and the Epilepsy Foundation Depression: A Checklist. A multiple regression model indicated which PIES measures were associated with scores from the comparator instruments. Questions in each of the domains were selected for correlations and nonduplication. Test-retest consistency at a 3-day interval was completed by 38 subjects and a final set of questions constructed.

RESULTS

The final question set comprised 25 items: 9 about characteristics of seizures, 7 about medication side effects, 8 about comorbidities, and 1 about overall quality of life. All items had 5 response choices (0-4), with higher scores reflecting more negative status. A total of 46 subjects completed the 25 questions. Cronbach's alpha was 0.87, indicating good internal consistency. Each of the three domains correlated well with the overall QOL item. The questions pertaining to seizures correlated with the NHSSS, the side effect questions with the LAEP, and the comorbidity questions with the QOLIE-31.

CONCLUSION

The PIES provides a simple, brief PRO measure as a profile of overall impact of seizures, medication side effects, comorbidities, and overall QOL for people with epilepsy. Further study will explore sensitivity to change quantification of the minimal clinically significant change.

Psychometric properties of the modified Czech version of the children self-report Quality-of-life Measure for Children with Epilepsy (CHEQOL-25)

Quality of life (QoL) is a crucial factor in the treatment of individuals suffering from epilepsy. We aimed to adapt the children's version of the CHEQOL-25 questionnaire to allow the QoL measurement in children suffering from epilepsy in the Czech Republic. The adaptation was conducted on a group of 250 children and adolescents aged 8-15years. It was found that the questionnaire required modification to fit the Czech pediatric population. Indirect questions were changed to direct questions, and two items were omitted from the original version of the questionnaire. The reasons for these modifications are discussed. The modified questionnaire was subjected to exploratory factor analysis, and a 4-factor structure was favored over the 5-factor structure of the original version. The internal consistency measured using Cronbach's alpha was found to be in the range of 0.78-0.83 for the individual scales, and test-retest reliability was expressed using intraclass correlation coefficient which was found to be in the range of 0.65-0.75. The modified Czech version of the CHEQOL-25 questionnaire displayed very good results with regard to construct validity. Its strength is its simplicity and clarity which allows it to be used in children with impaired cognitive functions. The results showed that the modified version of the Czech CHEQOL-25 has very good psychometric properties and could be used in further research and clinical practice.

'With the benefit of hindsight': would you opt again for epilepsy surgery performed in childhood?

BACKGROUND

How adolescents and their caregivers look back on epilepsy surgery performed in early life, and whether epilepsy-related restrictions are still in force years after the operation, are insufficiently known.

AIMS

To obtain retrospective evaluations of the decision for epilepsy surgery at an early age, and to inventory current epilepsy-related restrictions.

METHODS

Of 177 children who underwent epilepsy surgery between 1992 and 2009, 129 could be approached. They and their parents received a rating list inventorying whether, in retrospect, they would opt again for epilepsy surgery, which were motives for their answer, how successful they felt surgery had been and which, if any, epilepsy-related restrictions were still in force.

RESULTS

Forty-one of 44 seizure-free adolescents and 9 of 10 adolescents with current seizures were inclined to (re-)opt for surgery. Parents also would in majority re-opt for surgery. Age at surgery, post-surgical interval, nor type of surgery was statistically significantly related with re-opting for surgery. Seizure-freedom was the paramount motive of seizure-free respondents; respondents with current seizures in majority mentioned amelioration of seizures and/or medication. For parents of children with current seizures, a better developmental perspective was another important motive. Rare hesitation/refusal was related to uncertainties in weighing advantages and disadvantages. Current seizures were no reason to consider surgery as a failure. Among children who were free of both seizures and anti-epileptic drugs, 42% lived with restrictions.

CONCLUSIONS

Epilepsy surgery that does not result in seizure freedom is nevertheless felt to be beneficial. Proper advice should prevent meaningless continuation of restrictions.

Parenting and restrictions in childhood epilepsy

PURPOSE

From the overprotection literature, the predictive and interactional (moderation) effects of controlling and indulgent parenting on restrictions in children with epilepsy were examined.

METHODS

Parents of 73 children with epilepsy completed questionnaires on parenting, restrictions, and functional status. Predictive and moderation effects were tested using multiple regression analysis. Moderation was tested with interactive computational methods.

RESULTS

Restrictions were significantly (R(2)=.38, FΔ=6.59***, p<.001) predicted from seizure frequency (β=.24*, p<.05), functional status (β=-.42***, p<.001), and interaction between controlling and indulgent parenting (β=.28**, p<.01). Moderation occurred predominantly for high values of control: controlling parents who were not indulgent imposed fewer restrictions. In contrast, controlling parents who were indulgent imposed more restrictions.

CONCLUSION

Parents who were controlling and more indulgent imposed more restrictions. Clinicians should ask parents about parenting and restrictions. Future research should examine whether the current study's findings can be replicated.

Behavioural and cognitive effects during vagus nerve stimulation in children with intractable epilepsy - a randomized controlled trial

BACKGROUND/AIMS

In addition to effects on seizure frequency in intractable epilepsy, multiple studies report benefits of vagus nerve stimulation (VNS) on behavioural outcomes and quality of life. The present study aims to investigate the effects of VNS on cognition, mood in general, depression, epilepsy-related restrictions and psychosocial adjustment in children with intractable epilepsy, as well as the relation between these effects and seizure reduction.

METHODS

We conducted a randomized, active-controlled, double-blinded, add-on study in 41 children (age 4-18) with medically refractory epilepsy. We performed cognitive and behavioural testing at baseline (12 weeks), at the end of the blinded phase (20 weeks) in children receiving either high-output or low-output (active control) stimulation, and at the end of the open label phase (19 weeks) with all children receiving high-output stimulation. Seizure frequency was recorded using seizure diaries.

RESULTS

VNS did not have a negative effect on cognition nor on psychosocial adjustment. At the end of the follow-up phase we noted an improvement of mood in general and the depression subscale for the entire group, unrelated to a reduction of seizure frequency. At the end of the blinded phase a ≥50% reduction of seizure frequency occurred in 16% of the high-stimulation group and 21% of the low-stimulation group. At the end of the open-label follow-up phase, 26% of the children experienced a seizure frequency reduction of 50% or more (responders).

CONCLUSIONS

VNS has additional beneficial effects in children with intractable epilepsy. As opposed to anti-epileptic drugs, there are no negative effects on cognition. Moreover, we observed an improvement of mood in general and depressed feelings in particular, irrespective of a reduction in seizure frequency. These beneficial effects should be taken into account when deciding whether to initiate or continue VNS treatment in these children.

Self-reported and parent-reported quality of life of children and adolescents with new-onset epilepsy

PURPOSE

To investigate the self-reported quality of life (QOL) of children and adolescents with new-onset epilepsy and explore parent's perceptions of their child's QOL and the impact of epilepsy on the family.

METHODS

As part of the Standard and New Antiepileptic Drug (SANAD) trial, 248 children (aged 8-15 years) with new-onset epilepsy and their parents completed batteries of QOL measures. Children completed the KINDL and subscales of the QOLIE-AD-48. Parental questionnaires included the Rutter Parent Scales, Adverse Events Profile, and subscales of the Child Health Questionnaire.

KEY FINDINGS

Compared with published norms, children with epilepsy had significantly poorer QOL across multiple domains compared with healthy children and children with asthma. Parents, particularly of younger children and those with other long-term health problems, were affected by their child's health or behavior, which affected their emotional well-being and time for their own needs.

SIGNIFICANCE

Children with new-onset epilepsy, particularly those with comorbid conditions, are at risk of reduced QOL at the time of diagnosis. It is important that children with epilepsy and their families are assessed for psychosocial problems so that early intervention can be undertaken.

Research into the (Cost-) effectiveness of the ketogenic diet among children and adolescents with intractable epilepsy: design of a randomized controlled trial

Background

Epilepsy is a neurological disorder, characterized by recurrent unprovoked seizures which have a high impact on the individual as well as on society as a whole. In addition to the economic burden, epilepsy imposes a substantial burden on the patients and their surroundings. Patients with uncontrolled epilepsy depend heavily on informal care and on health care professionals. About 30% of patients suffer from drug-resistant epilepsy. The ketogenic diet can be a treatment of last resort, especially for children. The beneficial effect of the ketogenic diet has been proven, but information is lacking about its cost-effectiveness. In the current study we will evaluate the (cost-) effectiveness of the ketogenic diet in children and adolescents with intractable epilepsy.

Methods/Design

In a RCT we will compare the ketogenic diet with usual care. Embedded in this RCT will be a trial-based and model-based economic evaluation, looking from a societal perspective at the cost-effectiveness and cost-utility of the ketogenic diet versus usual care. Fifty children and adolescents (aged 1-18) with intractable epilepsy will be screened for eligibility before randomization into the intervention or the usual care group. The primary outcome measure is the proportion of children with a 50% or more reduction in seizure frequency. Secondary outcomes include seizure severity, side effects/complaints, neurocognitive, socio-emotional functioning, and quality of life. Costs and productivity losses will be assessed continuously by a prospective diary and a retrospective questionnaire. Measurements will take place during consults at baseline, at 6 weeks and at 4 months after the baseline period, and 3, 6, 9 and 12 months follow-up after the 4 months consult.

Discussion

The proposed research project will be the first study to provide data about the cost-effectiveness of the ketogenic diet for children and adolescents with intractable epilepsy, in comparison with usual care. It is anticipated that positive results in (cost-) effectiveness of the proposed intervention will contribute to the improvement of treatment for epilepsy in children and adolescents and will lead to a smaller burden to society.

Trial registration

The study has been registered with the Netherlands Trial Registry (NTR2498).

Seizure-related injuries in newly diagnosed childhood epilepsy

This study sought to evaluate seizure-related injuries in children under age 18 years with newly diagnosed epilepsy presenting at the Department of Pediatrics, Tuen Mun Hospital, in 2002-2003. All children were interviewed before January 2005. Children with seizure-related injuries were compared with those without injuries for identification of risk factors. One hundred and twenty-two children were surveyed. No patient died during a seizure. Eleven (9%) children manifested seizure-related injuries. Injury occurred at a mean age of 11.6 years, and epilepsy was diagnosed at a mean age of 13.8 years, in those with seizure-induced injuries. Injury occurred at first seizure presentation or upon diagnosis of epilepsy in 72.7% patients. Ten (90.9%) children were not receiving antiepileptic drugs at their time of injury. The mean age of seizure onset was 10.7 years in patients with injuries, and 6.7 years in control subjects (P = 0.007). Seizures resulting in injuries were generalized tonic-clonic in 72.7% (P = 0.045; odds ratio, 3.77; 95% confidence interval, 0.95-14.98). Idiopathic etiology was evident in 54.5%, and normal neurodevelopmental status in 72.7%, of patients with injuries. Age of seizure onset was the only independent variable retained after multivariate analysis. Soft-tissue and dental injuries comprised 91.7% and 75%, respectively, of injuries occurring at home. The risk of seizure-related injuries was substantial, especially before epilepsy was diagnosed, but most of these injuries were minor. These unique data could help in parental counseling.

Quality of life instruments for children and adolescents with neurodisabilities: how to choose the appropriate instrument

AIM

There are many misconceptions about what constitutes 'quality of life' (QoL). It is often difficult for researchers and clinicians to determine which instruments will be most appropriate to their purpose. The aim of the current paper is to describe QoL instruments for children and adolescents with neurodisabilities against criteria that we think are important when choosing or developing a QoL instrument.

METHOD

QoL instruments for children and adolescents with neurodisabilities were reviewed and described based on their purpose, conceptual focus, origin of domains and items, opportunity for self report, clarity (lack of ambiguity), potential threat to self-esteem, cognitive or emotional burden, number of items and time to complete, and psychometric properties.

RESULTS

Several generic and condition-specific instruments were identified for administration to children and adolescents with neurodisabilities - cerebral palsy, epilepsy and spina bifida, and hydrocephalus. Many have parent-proxy and self-report versions and adequate reliability and validity. However, they were often developed with minimal involvement from families, focus on functioning rather than well-being, and have items that may produce emotional upset.

INTERPRETATION

As well as ensuring that a QoL instrument has sound psychometric properties, researchers and clinicians should understand how an instrument's theoretical focus will have influenced domains, items, and scoring.

The Brazilian version of the Quality of Life in Epilepsy Inventory for Adolescents: translation, validity, and reliability

OBJECTIVE

The aim of this study was to translate and adapt the Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48) into Brazilian Portuguese, as well as to evaluate the psychometric properties of this Brazilian version.

METHODS

The QOLIE-AD-48 Brazilian version was tested with respect to reliability and validity in 93 adolescents with epilepsy. Patients completed the Self-Esteem Inventory (SEI), Children's Depression Evaluation Scale (CDES), and Adverse Events Profile (AEP). A subset of these patients were reexamined after 3-4 weeks to evaluate the test-retest reliability of the inventory. We assessed validity by comparing the QOLIE-AD-48 Brazilian version with external measures.

RESULTS

Internal consistency was satisfactory (Cronbach's alpha=0.87). Test-retest reliability was acceptable as well (intraclass correlation coefficient=0.52-0.81). Moreover, the QOLIE-AD-48 Brazilian version was highly correlated with other scales, demonstrating strong validity.

CONCLUSIONS

We conclude that the QOLIE-AD-48 Brazilian version has psychometric properties equivalent to those of the original American-English version and is a valid and reliable instrument for assessment of health-related quality of life in adolescents with epilepsy in Brazil or other Portuguese-speaking countries.

Parental view of epilepsy in Rett Syndrome

Few instruments exist to measure the impact of epilepsy on the quality of life in Rett Syndrome (RS).

METHODS

We attended to describe seizures characteristics, parental opinion and quality of life related in RS by using a newly developed self administered questionnaire, postal sent to parents of French Association for Rett Syndrome (AFSR).

RESULTS

Two-hundred completed questionnaires were returned. Mean age of patients was 14.8+/-8.1 years [3-42]. Parents reported that 70% of children had epileptic and non-epileptic seizures and mean age at first seizures was 7.3+/-5.1 years [1-24]. No statistical difference was found between the ages of first seizures, diagnosis of epilepsy and introduction of treatment. Seizures had a negative impact on child and family's life (68% of cases), strongly correlated to the existence of generalized, prolonged, cyanotic and drug-resistant seizures, on the child's level of alertness and progress in communication skills and psycho-social consequences such as fear of seizures, and difficulties to find home care aids.

CONCLUSIONS

We identified major concerns of parents with RS that determine the impact of seizures on children and their family's quality of life. Our results suggest that in order to improve seizures management in RS, better information should reduce fear about seizures and should improve the quality of life of RS.

Marked benefits in physical activity and well-being, but not in functioning domains, 2 years after successful epilepsy surgery in children

In this first study comparing epilepsy-specific quality-of-life measures of children after epilepsy surgery (2.4 years after focal resection) with those of a matched comparison group of nonoperated patients, seizure severity, medication side effects, overall quality of life, general health, physical activity, and well-being were better in surgical patients (70.6% seizure free vs 8.3%). Cognitive, social, and behavioral functioning did not differ, suggesting that these may require additional interventions during postsurgical follow-up.

Social skills problems in children with epilepsy: prevalence, nature and predictors

To determine the prevalence, nature, and predictors of social skills impairment in children with epilepsy, 101 parents completed the Social Skills Rating System, the Child Behavior Checklist, a general health questionnaire for both their child with epilepsy (aged 3-17) and his or her sibling, a quality-of-life assessment for the child with epilepsy, and Family Assessment Measure III. Epilepsy-specific variables were recorded for each case. Although children with epilepsy had poorer social skills (P<0.05) and were less assertive (P<0.006) than their siblings, the proportion with clinically significant social skills deficits was low and did not differ between groups (13% vs 7%, P=0.12). Neurological factors were related to social skills, but only presence of a learning disability (odds ratio=8.64, 95% CI=1.87-39.98) and abnormal family function (odds ratio=8.75, 95% CI=1.42-53.83) were strongly predictive of social skills impairment. Lower social skills were moderately correlated with epilepsy-specific and global quality of life (P<0.001).

Quality of life among Brazilian children with epilepsy: Validation of a parent proxy instrument (QVCE-50)

PURPOSE

To analyze the validity and reliability of an epilepsy specific health related quality of life (HRQL) instrument (QVCE-50), constructed for Brazilians. The QVCE-50 comprises the following domains: physical (9 items), psychological (18 items), social/familial (7 items), and cognitive/educational (16 items). Items were scored on a four point scale. Domains were equally weighted using percent scores. The questionnaire ends with a quality of life scale scored 0-10 and a space for free observations.

METHODS

A total of 77 children with epilepsy were consecutively seen in a neuropaediatric ambulatory unit. Parents or caregivers responded to the QVCE-50 and a Portuguese version of ICIS (Impact of Childhood Illness Scale). QVCE-50 was analyzed for internal consistency, reliability, content and concurrent validity. Clinical and socio-demographic variables were also analyzed.

RESULTS

Socio-demographic and clinical variables that differed in at least one domain were age, sex, time since diagnosis, epilepsy family history, and antiepileptic drug used. Internal consistency, analyzed by Cronbach's alpha, showed good results for total and domain scores: physical (0.68), psychological (0.86), socio-familiar (0.70) and cognitive-educational (0.91). Total scores on the QVCE-50 and ICIS are inversely correlated (Pearson's r=-0.74, p<0.0001). The Intraclass Correlation Coefficients for test-retest reliability were acceptable: physical (0.51), psychological (0.62), socio-familiar (0.66), cognitive-educational (0.85) and total (0.77), p<0.0001.

CONCLUSIONS

QVCE-50 has good psychometric properties. It is a useful tool for analyzing HRQL in children with epilepsy for Portuguese speakers, especially Brazilians. Other properties should be further tested, such as responsiveness to drug and surgical treatment, capacity of distinguishing among seizure control categories and etiology (with a larger sample) and impact of psychiatric and cognitive co-morbidities.

ADHD, Neurological Correlates and Health-related Quality of Life in Severe Pediatric Epilepsy

PURPOSE

ADHD is reported as a frequent comorbidity in pediatric epilepsy. We aimed to clarify the prevalence of ADHD, its neurological correlates and the role of ADHD in health-related quality of life (HRQOL) in children with severe epilepsy.

METHOD

Data from the ADHD Rating Scale-IV (ADHD-RS-IV) from 203 children (mean age = 11.8, SD=3.8) from a tertiary center serving children with severe epilepsy were reviewed.

RESULTS

Inattention was frequently elevated in the sample (40% vs. 18% for hyperactivity-impulsivity). Age of onset, epilepsy duration, and seizure frequency were not related to severity of inattention or hyperactivity-impulsivity. Over 60% of children met screening criteria for ADHD-Inattentive subtype (ADHD-I) or ADHD-Combined Inattentive/Hyperactive-Impulsive subtype (ADHD-C). Compared to ADHD-I, ADHD-C was associated with earlier onset of seizures, generalized epilepsy, lower adaptive level, and in normally developing children, a higher degree of intractability compared to ADHD-I. ADHD-I was more prevalent in localization-related epilepsy, and there was a trend for a higher use of AEDs with cognitive side effects in this group. ADHD was associated with poor HRQOL: children with ADHD-I and ADHD-C had a two- and four-fold likelihood of low HRQOL, respectively, compared to non-ADHD children.

CONCLUSIONS

Children seen at tertiary care centers for severe epilepsy are at high risk for attention problems and ADHD, and ADHD is a significant predictor of poor HRQOL in epilepsy, particularly in the case of ADHD-C. ADHD occurring in the context of severe epilepsy appears to be associated with specific neurological characteristics, which has implications for comorbidity models of ADHD and epilepsy.

Postsurgical Health-related Quality of Life (HRQOL) in Children Following Hemispherectomy for Intractable Epilepsy

Health-related quality of life (HRQOL) is an important outcome measure in clinical research. Given the psychosocial and behavioral difficulties associated with pediatric epilepsy, evaluating HRQOL in this patient population is of particular importance. Though HRQOL has been examined in pediatric patients receiving focal resection or pharmacological (antiepileptic drug; AED) treatment, it has not been assessed in patients receiving hemispherectomy (HE) for intractable epilepsy. The current study evaluated HRQOL in a sample of pediatric HE cases (N=26) using previously validated questionnaires relative to surgical (N=30) and nonsurgical (N=84) comparison groups. Compared with focal resection and nonsurgical patients, parents of children who received HE reported similar levels of HRQOL. In surgical cases, worse HRQOL was correlated with residual seizure frequency. In both surgical and nonsurgical cases, female gender, higher AED load, and lower functional independence predicted worse HRQOL. Interestingly, HE status (i.e., having undergone HE) predicted fewer epilepsy-related limitations. Consistent with previous findings, AED load, in addition to lower functional abilities, appear particularly detrimental to life quality in pediatric epilepsy. HE, however, is not associated with increased risk for poor HRQOL. When considered in light of the multiple, significant risk factors for poor outcome associated with HE, children who undergo the procedure fare surprisingly well.

No deterioration in epilepsy and motor function in children with medically intractable epilepsy ineligible for surgery

The aim of this study was to examine whether severity of epilepsy, motor functioning, and epilepsy-related restrictions change in children with medically intractable epilepsy who are ineligible for epilepsy surgery. The study was a prospective, longitudinal, 2-year follow-up of 28 children (14 females, 14 males). Their median age was 6 years 1 month (range 7mo-15y 4mo). Seizure types were: complex partial seizures (n=16), secondary generalized seizures (n=7), simple partial seizures (n=2), and mixed seizures (n=3). Severity of seizures, motor impairments, motor development, activities of daily life, and epilepsy-related restrictions were rated at baseline and 6, 12, and 24 months thereafter. Seizure severity did not change significantly, nor did muscle strength, range of motion, or muscle tone. Motor retardation was ubiquitous but did not increase in 20 children without spasticity. Motor function of eight children with spasticity improved (Gross Motor Function Measure: baseline 70.5 [SD 35.5]; 24 months later 81.6 [SD 29.6], p < 0.05) but remained below reference values in four children. In the entire group, functional skills increased and caregiver assistance lessened. Restrictions did not change significantly. We conclude that during a 2-year follow-up period, in children with medically intractable epilepsy who do not have surgical intervention, seizure severity does not deteriorate, motor impairments do not increase, motor development does not deflect negatively, and activities of daily living and restrictions do not worsen.

Epilepsien im Jugendalter

Zusammenfassung: Der Beitrag stellt die Bedeutung chronischer Erkrankungen des Jugendalters im Hinblick auf die Interaktion mit allgemeinen normativen Entwicklungsaufgaben der Adoleszenz dar und spezifiziert dann die besonderen psychosozialen Charakteristika der Epilepsie als häufigste neurologische Erkrankung des Jugendalters. Die besondere Bedeutung der Compliance und Aspekte der Krankheitsbewältigung für Jugendliche mit Epilepsie werden im Hinblick auf wichtige entwicklungspsychologische Themen des Jugendalters diskutiert. Bedeutung und Ziele von Patientenschulung als zentraler Behandlungsbaustein bei chronischen Erkrankungen werden erläutert.

Factor structure and construct validity of the Chinese Health-Related Quality of Life Measure for Youth with Epilepsy

PURPOSE

Factor structure and construct validity of the Chinese version of the Health-Related Quality of Life Measure for Children with Epilepsy are reported.

METHODS

The Parent-Proxy Response Scale and Child Self-Report Scale of the measure were administered to 266 children and their parents (or primary caregivers). Exploratory factor analysis was used to determine the underlying factor structure of the instrument. Hypothesis testing was used to explore construct validity.

RESULTS

The Chinese version of the Health-Related Quality of Life Measure for Children with Epilepsy had the same five-factor structure as the Canadian version. Greater use of epilepsy-related services was associated with poorer quality of life. Quality of life was also poorer in children who had more seizures, took more than one anticonvulsant, had impaired cognition, and studied in special schools. Children who had close friends and spent more time in extracurricular activities with friends scored higher on the Interpersonal/Social subscale.

CONCLUSIONS

Our data provide evidence of the cross-cultural applicability of the translated instrument.

Executive Dysfunction Is a Significant Predictor of Poor Quality of Life in Children with Epilepsy

PURPOSE

Based on prior research indicating poor health-related quality of life (HRQOL) in children with attention-deficit/hyperactivity disorder, we investigated (1) whether executive functioning deficits were related to poor HRQOL in children with epilepsy, (2) how important these variables were in comparison to known predictors of HRQOL such as neurological factors, and (3) the extent to which clinical-level impairments in executive dysfunction predispose children to low HRQOL.

METHOD

Data included scores on the Behavior Rating Inventory of Executive Function (BRIEF) and HRQOL scales (The Impact of Childhood Illness Scale [ICI] and Hague Restrictions in Epilepsy Scale [HARCES]) for 121 children (mean age = 11.9, SD = 3.6) from a tertiary center serving children with severe epilepsy.

RESULTS

Correlations between the BRIEF and ICI total and subscore domains (child, parent, family, and treatment) were generally significant and moderate (e.g., r > or = 0.30, p < or = 0.001). BRIEF Global Executive Composite, number of antiepileptic drugs (AEDs), number of prior AEDs, and adaptive level all emerged as significant and unique predictors of HRQOL (R(2)= 0.36, adj. R(2)= 0.33, p < 0.0001). A clinically elevated BRIEF was associated with a twofold risk of low HRQOL (odds ratio = 2.21, p = 0.03).

CONCLUSIONS

Executive dysfunction appears to exert a broad adverse influence on HRQOL in children with epilepsy, with clinical-level impairments in executive dysfunction contributing to a twofold increase in the likelihood of poor HRQOL. The constellation of executive dysfunction, low adaptive level, high medication load, and a history of several failed AEDs are risk factors for poor HRQOL in children with epilepsy.

Epilepsy-related Injuries

Only one prospective, controlled study has compared the risk of accidental injury in persons with epilepsy to controls without seizures. A mildly increased risk in the epilepsy group was found, predominantly due to injuries that result directly from a seizure. With regard to injury type, this study found significantly higher rates of only head and soft tissue injury; however, most injuries were minor. Several retrospective, population-based studies have suggested increased rates of more serious injury types. Submersion injury has a high mortality; the risk of submersion in children with epilepsy is 7.5-13.9 fold higher than in the general population. The risk of fracture is elevated approximately twofold, either resulting directly from seizure-induced injury or predisposed by drug-induced reduction in bone mineral density. Burns due to seizures account for between 1.6% and 3.7% of burn unit admissions. The risk of motor vehicle accidents in drivers with epilepsy also appears increased, albeit marginally. Several factors predispose to a higher risk of injury among those with epilepsy. Seizures resulting in falls increase the risk of concussion and other injuries. Higher seizure frequency, lack of a prolonged seizure-free interval, comorbid attention deficit disorder, or cognitive handicap may also increase the risk of injury. While some restrictions are necessary to protect the safety of the person with epilepsy, undue limitations may further limit achievement of independence. Given the high morbidity and mortality of submersion injury, those with active epilepsy should bathe or swim only with supervision; however, showering is a reasonable option. Appropriate vitamin D and calcium supplementation and periodic measurement of bone mineral density in those at risk for osteopenia are recommended.

Chinese version of the parent-proxy health-related quality of life measure for children with epilepsy: translation, cross-cultural adaptation, and reliability studies

PURPOSE

The goal of this article is to report on the translation and reliability studies of the Parent-Proxy Response Scale of Quality of Life Measure for Children with Epilepsy for Hong Kong Chinese children.

METHODS

In phase 1, forward and backward translations, expert panel review, and a series of pilot testing, cognitive interviewing, and pretesting with parents produced a Chinese translation. Content validity of the translated instrument was assessed. In phase 2, internal consistency was evaluated in 40 parents of children with epilepsy aged 8 to 18. Test-retest reliability was studied in 33 parents.

RESULTS

The translation was judged to have good content validity by experts and was acceptable to parents. Internal consistency was good (Cronbach alpha=0.71-0.92). Test-retest reliability, determined with the intraclass correlation coefficient, ranged between 0.51 and 0.84.

CONCLUSIONS

Our data suggest acceptable content validity, internal consistency, and reliability of the Chinese version of the Parent-Proxy Response Scale of the Quality of Life Measure for Children with Epilepsy. Studies with larger samples should be performed to further confirm other psychometric properties of the translated instrument.

Development and validation of a health related quality of life questionnaire for Brazilian children with epilepsy: preliminary findings

PURPOSE: To construct a multidimensional questionnaire that analyses the epileptic child quality of life from the parental point of view. METHOD: The pilot questionnaire was composed of 157 questions distributed in several dimensions. Fifty-one epileptic children's parents answered the questionnaire. The instrument was tested in its diverse properties: frequency of endorsement, homogeneity (Cronbach alpha), criterion and face validity, and later it was reduced. RESULTS: Endorsement frequency excluded 65 questions that did not attain a minimum of 5% response per item. Cronbach alpha was as follows: physical (0.93), psychological (0.91), social (0.91), familiar (0.70), cognitive (0.92), medical (0.30) and economical (0.37). Patient groups, in relation to seizure control, significantly differed only in physical domain and total score, although there was a trend to differences in other domains. The final questionnaire (QVCE50) has 50 items, with good homogeneity in the physical, psychological and cognitive domains. CONCLUSION: QVCE-50 is a promissing Brazilian HRQL questionnaire for children with epilepsy.It needs to be applied in a larger population to confirm its psychometric properties.

Health-related Quality of Life and Self-perceived Competence of Children Assessed before and up to Two Years after Epilepsy Surgery

PURPOSE

To measure outcome of epilepsy surgery in terms of health-related quality of life (HrQoL) and self-perceived competence of children and adolescents.

METHODS

Prospective longitudinal follow-up study of 21 patients (aged 6.2 to 16.8 years). Frequency and severity of seizures and epilepsy-related restrictions, HrQoL, and self-perceived competence were rated before and 6, 12, and 24 months after epilepsy surgery. Data were analysed nonparametrically and using analysis of variance for repeated measures.

RESULTS

Group-wise, seizure parameters had almost normalized 6 months after surgery (p<0.001) and remained so. Two years after surgery, 15 (72%) patients were free of seizures. At the first postsurgical assessment, parents and children evaluated the frequency of activities as improved and that of seizures as diminished (p<0.05). Parents evaluated their children as having positive emotions more frequently (p<0.05). Children started to feel better about seizure variables in the second year after surgery. Two years after surgery, children perceived themselves as being socially more competent and having greater self-worth (p=0.05). In the adolescent group, several aspects of self-perceived competence improved shortly after surgery (p<0.05), whereas 2 years after surgery, athletic competence and romance had improved (p<0.05).

CONCLUSIONS

In children and adolescents, epilepsy surgery sets the stage for improvement in HrQoL and in competence to participate in social and societal domains. Most improvement occurs in the first 6 months after surgery.

Correlates of quality of life with epilepsy

OBJECTIVE

To examine the quality of life of children with epilepsy and to identify the demographic, disease related, and behavioral and emotional functioning variables in the prediction of quality of life of children with epilepsy.

METHOD

Forty three children aged 4 to 15 years (Mean=10.3 years) with epilepsy were recruited from the outpatient services of the Department of Pediatrics, of a tertiary care teaching hospital in North India. Quality of life was measured by Impact of Epilepsy Schedule, a 39 items parent reported questionnaire and child's emotional and behavioral functioning at home was assessed by the Childhood Psychopathology Measurement Schedule.

RESULTS

Majority of the parents expressed major concerns regarding seizures, treatment by anticonvulsants, present and future problems for the child and problems in parenting. Nearly 40% of the children had psychopathology scores in the clinically significant maladjustment range. Step-wise multiple regression analysis revealed that the psychopathology scores and mother's education accounted for 39% of the variance in the quality of life scores.

CONCLUSION

Children with epilepsy have a relatively compromised quality of life and focusing simply on control of seizures may not address the full range of child's emotional and behavioral difficulties.

Validation of the German version of the Pediatric Quality of Life Inventory (PedsQL) in childhood cancer patients off treatment and children with epilepsy

The Pediatric Quality of Life Inventory (PedsQL) is a relatively new instrument developed in the US to assess health-related quality of life (HRQL) in healthy and ill children and adolescents. It is quick and easy to use, suitable for assessment by children and parents and based on a modular approach with a generic measure addressing all general domains of HRQL and disease-specific modules. We report here the results of translating the original US generic core instrument and the cancer module into German and testing the German PedsQL in samples of paediatric patients who have been treated for cancer or epilepsy. Like in studies with the original instrument, score distributions tended to be skewed toward higher HRQL, but a full response range was demonstrated for each item. The German PedsQL is reliable in terms of internal consistency with the majority of scales exceeding a Cronbach's alpha of 0.70. Clinical validity was confirmed by differences between the cancer and epilepsy groups in the expected direction and by the ability of the PedsQL to discriminate between subjects with different degrees of medical and psychosocial sequelae. Comparing our findings to US results, the German PedsQL seems to be equivalent to the original version. Future methodologic research should evaluate construct validity, sensitivity and responsiveness, and test the usefulness of the instrument in other clinical populations and healthy children.