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Kaşak M, Çıtak Kurt AN, Tural Hesapçıoğlu S, Ceylan MF. Psychiatric comorbidity and familial factors in childhood epilepsy: Parental psychopathology, coping strategies, and family functioning. Epilepsy Behav 2023; 148:109444. [PMID: 37748417 DOI: 10.1016/j.yebeh.2023.109444] [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: 06/12/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE This study aimed to examine the psychiatric diagnoses, parenting attitudes, family functioning among children and adolescents with epilepsy, coping styles of their mothers, and psychiatric symptoms of their mothers and fathers. METHODS Forty children and adolescents between the ages of 8 and 18 with epilepsy and 40 healthy controls were included in the study. The clinical interview and other measurements were used to assess psychiatric disorders and familial factors. RESULTS At least one psychiatric disorder was diagnosed in 65% of children and adolescents with epilepsy. It was determined that the mothers and fathers in the epilepsy group had higher anxiety and depression scores than the control group, and the fathers' hostility scores were also higher. The Family Assessment Device (FAD) (problem-solving and affective responsiveness), Coping Strategies Scale (COPE) (mental disengagement and substance use), and Parent Attitude Scale (PAS) (strictness/supervision) subtest scores of the epilepsy group were higher than the control group. CONCLUSION Psychiatric comorbidities, especially depression, anxiety disorders, and attention deficit hyperactivity disorder, are more common in children and adolescents with epilepsy. The mental health of parents, parent-child relationships, family functioning, and parental coping styles were adversely affected in families with children with epilepsy. It is essential to evaluate psychiatric comorbidity and family factors in children with epilepsy and to create a treatment plan for problem areas.
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Affiliation(s)
- Meryem Kaşak
- Department of Child and Adolescent Psychiatry, Ankara City Hospital, Ankara, Turkey.
| | - Ayşegül N Çıtak Kurt
- Department of Pediatric Neurology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Selma Tural Hesapçıoğlu
- Department of Child and Adolescent Psychiatry, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
| | - Mehmet Fatih Ceylan
- Department of Child and Adolescent Psychiatry, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
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Kertesz-Briest HA, H Hamilton A, Hartline K, Klein MJ, Gold JI. Examining relations between neuropsychological and clinical epilepsy-specific factors with psychopathology and adaptive skills outcomes in youth with intractable epilepsy. Epilepsy Behav 2020; 110:107171. [PMID: 32585476 DOI: 10.1016/j.yebeh.2020.107171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022]
Abstract
Pediatric epilepsy is a prevalent childhood neurological disorder. Youth with a diagnosis of medically uncontrollable or intractable epilepsy are at increased risk for poor neurocognitive and psychosocial functioning. To date, there is a paucity of clinical research examining and/or characterizing the relations of neuropsychological, clinical, and epilepsy-specific medical factors in clinical outcomes among youth with diagnosed intractable epilepsy. One hundred and twenty-six patients (6-20 years) with diagnosed intractable epilepsy and who were evaluated as part of a presurgical work-up and medical standard of care participated in a neuropsychological evaluation, including parent completion of the Behavior Assessment System for Children - Second Edition Parent Report Scale (BASC-2 PRS). Medical chart review was conducted to obtain demographic and epilepsy-specific information. Results indicated that an increase in the BASC-2 PRS Adaptive Symptoms Index T-Scores was associated with a decrease in the BASC-2 PRS Internalizing, Externalizing, and Behavioral Symptoms Index score. Additionally, the Wechsler (Wechsler Intelligence Scale for Children - Fourth Edition [WISC-IV], Wechsler Intelligence Scale for Children - Fifth Edition [WISC-V], Wechsler Adult Intelligence Scale - Fourth Edition [WAIS-IV]) Similarities z-score was associated with the BASC-2 PRS Externalizing Symptoms Index T-Score. No demographic or clinical medical factors remained in any of the three final models. Findings highlight the importance of verbal reasoning and adaptive functioning as protective factors in clinical outcomes among youth with diagnosed intractable epilepsy and may provide future direction for targeted interventions.
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Affiliation(s)
- Heather A Kertesz-Briest
- The Saban Research Institute at Children's Hospital Los Angeles, University Center for Excellence in Developmental Disabilities, Los Angeles, CA, USA
| | - Anita H Hamilton
- The Saban Research Institute at Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Los Angeles, California, USA; Keck School of Medicine, University of Southern California, Department of Pediatrics, USA
| | - Kenneth Hartline
- The Saban Research Institute at Children's Hospital Los Angeles, Division of Neurology, Los Angeles, California, USA; Keck School of Medicine, University of Southern California, Department of Pediatrics, USA
| | - Margaret J Klein
- The Saban Research Institute at Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Los Angeles, California, USA
| | - Jeffrey I Gold
- The Saban Research Institute at Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Los Angeles, California, USA; Keck School of Medicine, University of Southern California, Department of Anesthesiology, USA; Keck School of Medicine, University of Southern California, Department of Psychiatry & Behavioral Sciences, USA.
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Gökçen O, Turgut M. An Overview of Anxiety Disorders and Depression in Children with Epilepsy: A Literature Review. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1715566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractComorbid psychiatric disorders in children with epilepsy have long been a subject of medical literature. Many studies conducted by pediatric neurologists, neurosurgeons, psychiatrists, and psychologists have revealed that psychiatric disorders, including anxiety disorders and depression, are frequently seen in children and adolescents with epilepsy. Due to various etiologies behind epilepsy, causes, manifestation, and treatment of anxiety and depression all have unique aspects. We think there are multiple reasons behind anxiety disorders and depression in children with epilepsy, varying from the physiological nature of the epilepsy itself to the environmental factors such as family, parenting, and social status. In this article, we aim to review the causes, risk factors, and management of anxiety disorders and depression in children with epilepsy.
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Affiliation(s)
- Onur Gökçen
- Psychiatry Clinic, Kütahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Mehmet Turgut
- Department of Neurosurgery, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey
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Rosic T, Avery L, Streiner DL, Ferro MA, Rosenbaum P, Cunningham C, Ronen GM. Longitudinal trajectories of depression symptoms in children with epilepsy. Dev Med Child Neurol 2020; 62:593-599. [PMID: 31696940 DOI: 10.1111/dmcn.14387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 01/25/2023]
Abstract
AIM To examine self- and proxy-reported symptoms of depression in children with epilepsy. METHOD This was a prospective longitudinal cohort study of children with epilepsy. Participants were treated at six Canadian tertiary-care centers and followed over 28 months with repeated assessments of child self-reported symptoms of depression using the Children's Depression Inventory Short-Form (CDI-S). Trajectories of symptoms of depression were estimated using linear mixed effects (LME) modeling. RESULTS At baseline, 477 children had complete data (mean age [SD] 11y 5mo [2y 1mo], range 7y 7mo-15y 1mo; 234 females, 243 males). Mean CDI-S T score at baseline was 45.7 (SD=7.5) and at 28 months was 44.9 (SD=8.2), both were within the 'average' range. Results from LME modeling revealed mean raw CDI-S score of 1.897, corrected for age 10 years (corresponding to T scores slightly below the normed mean of 50), with no significant change over three measurements (slope=-0.113, p=0.135), indicating that CDI-S scores were stable over 28 months. Children with high initial CDI-S scores had lower subsequent scores, as demonstrated by the correlation of -0.827 between intercept and slope (p<0.001). Parents reported comparable findings. INTERPRETATION Self- and proxy-reported symptoms of depression were generally low and stable over an extended follow-up period. Normalization of scores was seen upon repeated assessment, even in children with higher scores of symptoms of depression at one point. These findings speak to the value and importance of repeated assessment over time. WHAT THIS PAPER ADDS In children with epilepsy, self- and proxy-reported symptoms of depression were generally low and stable over 28 months. The trajectory of symptoms of depression was not associated with seizure severity, whether considering the frequency or type of seizures. Parents' reports of symptoms of depression were comparable to the children's self-evaluations.
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Affiliation(s)
- Tea Rosic
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Avery
- Avery Information Services, Orillia, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Charles Cunningham
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Chew J, Carpenter J, Haase AM. Living with epilepsy in adolescence-A qualitative study of young people's experiences in Singapore: Peer socialization, autonomy, and self-esteem. Child Care Health Dev 2019; 45:241-250. [PMID: 30693552 DOI: 10.1111/cch.12648] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/23/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Systematic reviews of quantitative research on the effects of childhood epilepsy have established its association with higher levels of psychiatric diagnosis, externalizing and internalizing problems, lower health-related quality of life, social competence, and poorer academic achievements, compared with their peers. However, much less is known about young people's experiences of living with epilepsy and its impact on their development from their own perspectives. METHODS Semistructured interviews were conducted with 15 young people aged between 13 and 16 years. Participants were recruited as part of a larger mixed methods study examining individual and family influences on outcomes for young people with epilepsy. These young people attended an epilepsy clinic in KK Women's and Children's Hospital, Singapore. The framework approach to data management and analyses involved both inductive and deductive generation of themes. RESULTS Findings from young people's interviews provided in-depth descriptions of stressful circumstances encountered. Interconnectedness between severity of the impairment and its impact on key developmental tasks, such as independence, autonomy, and social development, were emphasized. Seizures and illness-related demands disrupted their day-to-day functioning and challenged their abilities to meet these tasks. In addition to these impairment effects, young people's experiences of social exclusion were also affected by social and environmental factors, which act as systemic barriers to participation. In turn, this has an effect on their self-esteem. Nevertheless, young people reported positive experiences, such as support from both family and friends, which served as protective factors against the stress of living with a chronic medical condition. CONCLUSION The demands of epilepsy affect various domains of young people's lives. In order to obtain a holistic understanding of young people's inclusion or exclusion to participation, it is necessary to consider impairment effects, barriers to doing, and barriers to being.
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Affiliation(s)
- Judith Chew
- Medical Social Work Department, KK Women's and Children's Hospital, Singapore
| | - John Carpenter
- Social Work and Applied Social Science, School for Policy Studies, University of Bristol, Bristol, UK
| | - Anne M Haase
- School for Policy Studies, University of Bristol, Bristol, UK.,Centre for Exercise, Nutrition and Health, School for Policy Studies, University of Bristol, UK.,Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center
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Coppola G, Operto FF, Matricardi S, Verrotti A. Monitoring And Managing Depression In Adolescents With Epilepsy: Current Perspectives. Neuropsychiatr Dis Treat 2019; 15:2773-2780. [PMID: 31576132 PMCID: PMC6765392 DOI: 10.2147/ndt.s192714] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/02/2019] [Indexed: 11/23/2022] Open
Abstract
Epilepsy is associated with a significantly increased risk of developing depressive disorder during adolescence. On the other hand, depression is highly detected in adolescents with epilepsy. These findings highlight the importance of early identification and proper management of comorbid depression in adolescent age. The prevalence of depressive disorders in adolescents with epilepsy ranges between 8 and 35% and is higher than the general population of the same age. The relationship between epilepsy and depression is complex and potentially bidirectional, thereby suggesting a common underlying pathophysiology. Furthermore, failure to detect and treat depressive disorder mostly in adolescence could lead to several negative implications such as an increased risk of suicidal ideation or behavior and poor quality of life. A number of methods are available to detect depressive disorder, such as psychiatric or psychological assessments, structured or semi-structured interviews, and self-report screening tools. Thus, physicians should be able to regularly screen depressive symptoms in youths with epilepsy. Recently, the NDDI-E-.Y inventory has been developed from the adult NDDI-E, and has been validated in many countries. NDDI-E-Y has showed reliable validity, being a brief screening tool (12 items) that can be easily included in routine epilepsy care. The first step to be considered for the management of depressive disorder in adolescents with epilepsy is to consider potential reversible causes of anxiety and depression (i.e., a new AEDs; seizure control). Secondly, great attention has to be given to the education of the child/adolescent and his/her family, trying to improve knowledge about epilepsy as well as to decrease parental stress and improving the child's sense of competence. Pharmacological treatment should also be considered in adolescents diagnosed with depression.
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Affiliation(s)
- Giangennaro Coppola
- Child and Adolescent Neuropsychiatry, Department of Medicine, Surgery, and Odontoiatry, University of Salerno, Salerno, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry, Department of Medicine, Surgery, and Odontoiatry, University of Salerno, Salerno, Italy
| | - Sara Matricardi
- Department of Pediatric Neurology, Ospedali Riuniti, Ancona, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
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Abstract
PURPOSE OF REVIEW To review some aspects of the relationship between epilepsy and depression that have recently received increasing attention and may become major research topics in the near future. RECENT FINDINGS Epidemiological studies show that depression and suicide are, in some cases, premorbid symptoms preceding the onset of the epilepsy. Suicide is also three times more frequent in epilepsy than in the general population. Reliable screening instruments for depression and suicidality in patients with epilepsy are now available but data from real life clinical settings are needed to develop shared clinical pathways between neurology and psychiatry. Data in children with epilepsy are still limited although it is well known that, outside epilepsy, almost 50% of adult patients with mood and anxiety disorders have a previous history during childhood. Despite increasing attention to the problem, the additional stigma associated with mental health problems still represents one of the major barriers to prompt diagnosis and treatment. SUMMARY New studies will focus on the development of shared clinical pathways between neurology and psychiatry for mood disorders and suicide prevention. New global campaigns on the double stigma will support this process in areas where psychiatric comorbidities are still underdiagnosed and undertreated.
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Fong CY, Chang WM, Kong AN, Rithauddin AM, Khoo TB, Ong LC. Quality of life in Malaysian children with epilepsy. Epilepsy Behav 2018; 80:15-20. [PMID: 29396357 DOI: 10.1016/j.yebeh.2017.12.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/24/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
| | - Wei Mun Chang
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Paediatric Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Ann Nie Kong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | - Teik Beng Khoo
- Paediatric Neurology Unit, Paediatric Institute, Hospital Kuala Lumpur, Malaysia
| | - Lai Choo Ong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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Cianchetti C, Bianchi E, Guerrini R, Baglietto MG, Briguglio M, Cappelletti S, Casellato S, Crichiutti G, Lualdi R, Margari L, Romeo A, Beghi E. Symptoms of anxiety and depression and family's quality of life in children and adolescents with epilepsy. Epilepsy Behav 2018; 79:146-153. [PMID: 29289902 DOI: 10.1016/j.yebeh.2017.11.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/23/2017] [Accepted: 11/26/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We studied children and adolescents with epilepsy (CAWE) and their families to evaluate symptoms of anxiety and depression, quality of life (QoL), and their correlations with epilepsy characteristics. MATERIAL AND METHODS The study included 326 (52.5% females) 8 to 18years old CAWE. Anxiety and depression were assessed with the "Self-administered psychiatric scales for children and adolescents" (SAFA), and family's QoL with the parents' report "Impact of Epilepsy on QoL" (IEQoL). RESULTS The CAWE exhibiting abnormal (T≥70) scores were 8.0% in the anxiety scale, 9.2% in the depression scale, and 4.6% in both scales. Social anxiety was the predominant anxiety symptom, while irritable mood and desperation were the most frequent symptoms of depression. Depressive symptoms were associated with parents' complaint of higher worries about the child's condition and future and lower well-being of the family. Severity and duration of the epilepsy and polypharmacy were independent from abnormal scores of anxiety and depression, but were associated with parents' worries about the child's condition and family's well-being. CONCLUSIONS Anxiety and depression in CAWE are independent from the characteristics of the disease but are correlated to the lower well-being of the family. A search of these emotional problems is recommended for better care of the patients and their families.
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Affiliation(s)
- Carlo Cianchetti
- Child and Adolescent Neuropsychiatry, University of Cagliari, Italy.
| | - Elisa Bianchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri", IRCCS, Milano, Italy
| | - Renzo Guerrini
- Neuroscience Dept., Children's Hospital A. Meyer, University of Firenze, Italy
| | | | | | - Simona Cappelletti
- Clinical Psychology Unit, Neuroscience Dept., Bambino Gesù Children's Hospital, Roma, Italy
| | - Susanna Casellato
- Epilepsy Unit, Child and Adolescent Neuropsychiatry, University of Sassari, Italy
| | | | - Rosa Lualdi
- Medical Area Dept, University of Udine, Italy
| | - Lucia Margari
- Child and Adolescent Neuropsychiatry, University of Bari, Italy
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri", IRCCS, Milano, Italy
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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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Kellermann TS, Mueller M, Carter EG, Brooks B, Smith G, Kopp OJ, Wagner JL. Prediction of specific depressive symptom clusters in youth with epilepsy: The NDDI-E-Y versus Neuro-QOL SF. Epilepsia 2017; 58:1370-1379. [DOI: 10.1111/epi.13808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Tanja S. Kellermann
- Department of Neurosurgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Martina Mueller
- College of Nursing; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Emma G. Carter
- Department of Neurology; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Byron Brooks
- Department of Psychology; East Tennessee State University; Johnson City Tennessee U.S.A
| | - Gigi Smith
- College of Nursing; Medical University of South Carolina; Charleston South Carolina U.S.A
- Comprehensive Epilepsy Program; Medical University of South Carolina; Charleston South Carolina U.S.A
- Department of Pediatrics; Medical University of South Carolina; Charleston South Carolina U.S.A
| | | | - Janelle L. Wagner
- College of Nursing; Medical University of South Carolina; Charleston South Carolina U.S.A
- Comprehensive Epilepsy Program; Medical University of South Carolina; Charleston South Carolina U.S.A
- Department of Pediatrics; Medical University of South Carolina; Charleston South Carolina U.S.A
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Chew J, Haase AM, Carpenter J. Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis. Epilepsy Behav 2017; 66:19-26. [PMID: 27987477 DOI: 10.1016/j.yebeh.2016.09.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE As young people experience added demands from living with epilepsy, which may lead to poor psychosocial adjustment, it is essential to examine mechanisms of change to provide practitioners with knowledge to develop effective interventions. The aim of this study was to examine individual and family-level factors - stress and illness perceptions, coping behaviors and family resilience - that promote or maintain young people's self-esteem. METHODS From November 2013 to August 2014, young people attending a neurology clinic in KK Women's and Children's Hospital, Singapore, participated in a cross-sectional survey (n=152; 13-16years old). Multiple mediation analyses were conducted to evaluate whether these variables mediated the relationship between illness severity (i.e., low, moderate, high) and self-esteem. RESULTS Multiple mediation analyses demonstrated that illness severity had a direct effect on young people's self-esteem. Compared to those with moderate illness severity (reference group), young people with low severity had significantly higher self-esteem (c=3.42, p<0.05); while those with high severity had a more negative view of themselves (c=-3.93, p<0.001). Illness severity also had an indirect influence on self-esteem through its effects on mediators, such as perceived stress, illness perceptions and family resilience (D1: Total ab=3.46, 95% CI 1.13, 5.71; D2: Total ab=-2.80, 95% CI -4.35, -1.30). However, young people's coping levels did not predict their self-esteem, when accounting for the effects of other variables. SIGNIFICANCE The continued presence of seizure occurrences is likely to place greater demands on young people and their families: in turn, increased stress and negative illness perceptions negatively affected family processes that promote resilience. As the mediating effect of these modifiable factors were above and beyond the contributions of illness characteristics and young people's levels of coping, this has implications for developing individual and family interventions aimed to support young people living with epilepsy.
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Affiliation(s)
- Judith Chew
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom.
| | - Anne M Haase
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom
| | - John Carpenter
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom
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Wagner JL, Smith G. In response: Neurological Disorders Depression Inventory-Epilepsy for Youth. Epilepsia 2016; 57:1730-1731. [PMID: 27718241 DOI: 10.1111/epi.13511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Janelle L Wagner
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
| | - Gigi Smith
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Kwong KL, Lam D, Tsui S, Ngan M, Tsang B, Lai TS, Lam SM. Self-esteem in adolescents with epilepsy: Psychosocial and seizure-related correlates. Epilepsy Behav 2016; 63:118-122. [PMID: 27636142 DOI: 10.1016/j.yebeh.2016.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/18/2016] [Accepted: 07/24/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE This study evaluated self-esteem in adolescents with epilepsy and its association with psychosocial and disease-related variables. METHODS This was a cross-sectional study with patients enrolled between January and June 2010. Culture-Free Self-Esteem Inventory for Children (CFSEI-2) was administered to 140 children with epilepsy and 50 children with asthma, aged 10-18years attending mainstream schools. RESULTS Adolescents with epilepsy had a significantly lower overall self-esteem score when compared with those with asthma, 17±5.21 versus 19.4±3.83, respectively (P=0.005). Thirty-one (22.1%) children with epilepsy compared with 4 (8.3%) with asthma had overall self-esteem score below the cutoff (P=0.034). There was a significant correlation between overall self-esteem score and duration of epilepsy, Hospital Anxiety and Depression Scale (HADS) anxiety score, HADS depression score, and Strengths and Weaknesses of ADHD symptoms and Normal-Behaviors (SWAN) rating combined score. The impact of various correlates on individual domains was not identical. Independent factors associated with low overall self-esteem were HADS depression score (OR: 1.62; 95% CI: 1.2, 2.2; P=0.002), duration of epilepsy (OR: 1.4; 95% CI: 1.04, 1.88; P=0.024), and father employment status economically inactive (OR: 11.9; 95% CI: 1.07, 125; P=0.044). Seizure-free ≥12months was a favorable factor that was less likely to be associated with low self-esteem (OR: 0.14; 95% CI: 0.02, 0.81; P=0.028). CONCLUSION Self-esteem was compromised in adolescents with epilepsy. A significant correlation between self-esteem and psychological comorbidities was demonstrated. Enhancing social support and education programs may improve the self-esteem and, ultimately, the lives of adolescents living with epilepsy.
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Affiliation(s)
- Karen Ling Kwong
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong.
| | - David Lam
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong
| | - Sarah Tsui
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong
| | - Mary Ngan
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong
| | - Brian Tsang
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong
| | - Tai Sum Lai
- Department of Child Psychiatry, Castle Peak Hospital, Hong Kong
| | - Siu Man Lam
- Department of Child Psychiatry, Castle Peak Hospital, Hong Kong
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15
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Ekinci O, Isik U, Gunes S, Yildirim C, Killi Y, Guler G. Self-concept in children and adolescents with epilepsy: The role of family functioning, mothers' emotional symptoms and ADHD. Brain Dev 2016; 38:714-22. [PMID: 26992474 DOI: 10.1016/j.braindev.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to identify the associated factors of poor self-concept in children and adolescents with epilepsy. METHODS Fifty-three patients with uncomplicated epilepsy (aged 7-18years) and 28 healthy controls were included. Study measures included the Piers-Harris 2 Self-Concept Scale, Family Assessment Device (FAD), Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S), Conners' Teacher Rating Scale (CTRS-R), Beck Depression Inventory and State-Trait Anxiety Inventory (STAI). Neurology clinic charts were reviewed for the epilepsy-related variables. RESULTS While the Piers-Harris 2 total score was not significantly different between the groups, patients with epilepsy had lower (poorer) scores on freedom from anxiety and popularity subscales. Linear regression analysis revealed that the problem solving, affective responsiveness, general functioning and communication scores of FAD; total and inattentiveness scores of T-DSM-IV-S and mothers' Beck scores were associated with the total score of Piers-Harris 2. Epilepsy-related factors were not found to be associated with self-concept scores. CONCLUSION Poor self-concept in children with epilepsy is associated with negative family functioning, mothers' emotional symptoms and ADHD, especially the symptoms of inattentiveness.
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Affiliation(s)
- Ozalp Ekinci
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey.
| | - Uğur Isik
- Department of Pediatrics, Division of Pediatric Neurology, Acıbadem University School of Medicine, Turkey
| | - Serkan Gunes
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
| | - Canan Yildirim
- Pediatric Neurology Department, Istanbul Erdem Hospital, Turkey
| | - Yunus Killi
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
| | - Gülen Guler
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
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16
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Chew J, Haase AM. Psychometric properties of the Family Resilience Assessment Scale: A Singaporean perspective. Epilepsy Behav 2016; 61:112-119. [PMID: 27337164 DOI: 10.1016/j.yebeh.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/26/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]
Abstract
Families of young people with chronic illnesses are more likely to experience higher levels of stress. In turn, their ability to cope with multiple demands is likely to affect young people's adaptation. The purpose of this study was to examine psychometric properties of the Family Resilience Assessment Scale (FRAS), an assessment tool that measures the construct of family resilience. A total of 152 young people with epilepsy, aged 13 to 16years old, from KK Women's and Children's Hospital, Singapore, completed the FRAS along with the Rosenberg Self-Esteem Scale. Factor structure of the FRAS was examined. Exploratory factor analysis resulted in a 7-factor solution - meaning-making and positive outlook, transcendence and spirituality, flexibility and connectedness, social and economic resources (community), social and economic resources (neighbors), clarity and open emotional expression, and collaborative problem-solving - accounting for 83.0% of the variance. Internal consistency of the scale was high (α=0.92). Family resilience was significantly correlated with higher levels of self-esteem. Our study provides preliminary findings that suggest that FRAS is a reliable and valid scale for assessing the construct of family resilience among young people with epilepsy in Singapore.
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Affiliation(s)
- Judith Chew
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom; Medical Social Work Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, S 229899, Singapore.
| | - Anne M Haase
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom
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17
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Conway L, Smith ML, Ferro MA, Speechley KN, Connoly MB, Snead OC, Widjaja E. Correlates of health-related quality of life in children with drug resistant epilepsy. Epilepsia 2016; 57:1256-64. [PMID: 27350597 DOI: 10.1111/epi.13441] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQL) is compromised in children with epilepsy. The current study aimed to identify correlates of HRQL in children with drug resistant epilepsy. METHODS Data came from 115 children enrolled in the Impact of Pediatric Epilepsy Surgery on Health-Related Quality of Life Study (PEPSQOL), a multicenter prospective cohort study. Individual, clinical, and family factors were evaluated. HRQL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE), a parent-rated epilepsy-specific instrument, with composite scores ranging from 0 to 100. A series of univariable linear regression analyses were conducted to identify significant associations with HRQL, followed by a multivariable regression analysis. RESULTS Children had a mean age of 11.85 ± 3.81 years and 65 (56.5%) were male. The mean composite QOLCE score was 60.18 ± 16.69. Child age, sex, age at seizure onset, duration of epilepsy, caregiver age, caregiver education, and income were not significantly associated with HRQL. Univariable regression analyses revealed that a higher number of anti-seizure medications (p = 0.020), lower IQ (p = 0.002), greater seizure frequency (p = 0.048), caregiver unemployment (p = 0.010), higher caregiver depressive and anxiety symptoms (p < 0.001 for both), poorer family adaptation, fewer family resources, and a greater number of family demands (p < 0.001 for all) were associated with lower HRQL. Multivariable regression analysis showed that lower child IQ (β = 0.20, p = 0.004), fewer family resources (β = 0.43, p = 0.012), and caregiver unemployment (β = 6.53, p = 0.018) were associated with diminished HRQL in children. SIGNIFICANCE The results emphasize the importance of child cognition and family variables in the HRQL of children with drug-resistant epilepsy. The findings speak to the importance of offering comprehensive care to children and their families to address the nonmedical features that impact on HRQL.
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Affiliation(s)
- Lauryn Conway
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Mark A Ferro
- Departments of Psychiatry and Behavioural Neurosciences and Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kathy N Speechley
- Departments of Paediatrics, Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Mary B Connoly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - O Carter Snead
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Kellermann TS, Bonilha L, Lin JJ, Hermann BP. Mapping the landscape of cognitive development in children with epilepsy. Cortex 2015; 66:1-8. [PMID: 25776901 DOI: 10.1016/j.cortex.2015.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/12/2014] [Accepted: 02/06/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Normal childhood development is defined by age-dependent improvement across cognitive abilities, including language, memory, psychomotor speed and executive function. Epilepsy is often associated with a global disruption in cognitive development, however, it is still largely unknown how epilepsy affects the overall organization of overlapping cognitive domains. The aim of the study was to evaluate how childhood epilepsy affects the developmental interrelationships between cognitive domains. METHODS We performed a comprehensive assessment of neuropsychological function in 127 children with new onset epilepsy and 80 typically developing children matched for age, gender, and socio-demographic status. A cross-correlation matrix between the performances across multiple cognitive tests was used to assess the interrelationship between cognitive modalities for each group (patients and controls). A weighted network composed by the cognitive domains as nodes, and pair-wise domain correlation as links, was assessed using graph theory analyses, with focus on global network structure, network hubs and community structure. RESULTS Normally developing children exhibited a cognitive network with well-defined modules, with verbal intelligence, reading and spelling skills occupying a central position in the developing network. Conversely, children with epilepsy demonstrated a less well-organized network with less clear separation between modules, and relative isolation of measures of attention and executive function. CONCLUSION Our findings demonstrate that childhood-onset epilepsy, even within its early course, is associated with an extensive disruption of cognitive neurodevelopmental organization. The approach used in this study may be useful to assess the effectiveness of future interventions aimed at mitigating the cognitive consequences of epilepsy.
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Affiliation(s)
- Tanja S Kellermann
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Leonardo Bonilha
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jack J Lin
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin, Madison, WI, USA.
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19
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Zashikhina A, Hagglof B. Self-esteem in adolescents with chronic physical illness vs. controls in Northern Russia. Int J Adolesc Med Health 2014; 26:275-81. [PMID: 23843571 DOI: 10.1515/ijamh-2013-0507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/06/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This work aims to study self-esteem in adolescents with diabetes, asthma and epilepsy; compare the results with those of the representative sample of healthy adolescents; and evaluate the predictive value of certain demographic, family-related, and disease-related factors on self-esteem. METHODS A total of 148 chronically ill adolescents and 301 matched healthy counterparts completed the Rosenberg Self Esteem Scale and the "I think I am" questionnaire. Adolescents' parents answered socio-economic status questions. Disease severity was evaluated by doctors of the outpatient clinic. RESULTS Comparison analysis of the three disease groups revealed highest self-esteem perception in adolescents with diabetes, and lowest in adolescents with epilepsy. Unexpectedly, adolescents with diabetes scored higher than their healthy counterparts. There were no significant differences between the reports of adolescents with asthma and controls. In the epilepsy group, self-esteem was predicted mostly by disease severity and socio-economic status in diabetes and asthma groups, as well as by age and gender. CONCLUSION The maintenance of positive self-esteem in adolescents with diabetes and asthma is a very reassuring finding. The other results of our study provide support for recognizing adolescents with epilepsy as a vulnerable group in the society. A multidisciplinary professional approach targeted on adolescents with epilepsy is needed, with focus on factors connected with maturation and gender issues.
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20
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Ferro MA. Risk factors for health-related quality of life in children with epilepsy: A meta-analysis. Epilepsia 2014; 55:1722-31. [DOI: 10.1111/epi.12772] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Mark A. Ferro
- Psychiatry & Behavioural Neurosciences; McMaster University; Hamilton Ontario Canada
- Pediatrics; McMaster University; Hamilton Ontario Canada
- Clinical Epidemiology & Biostatistics; McMaster University; Hamilton Ontario Canada
- Offord Centre for Child Studies; McMaster University; Hamilton Ontario Canada
- CanChild Centre for Childhood Disability Research; McMaster University; Hamilton Ontario Canada
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21
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Ferro MA, Chin RFM, Camfield CS, Wiebe S, Levin SD, Speechley KN. Convulsive status epilepticus and health-related quality of life in children with epilepsy. Neurology 2014; 83:752-7. [PMID: 25037204 DOI: 10.1212/wnl.0000000000000710] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The objective of this study was to examine the association between convulsive status epilepticus (CSE) and health-related quality of life (HRQL) during a 24-month follow-up in a multisite incident cohort of children with epilepsy. METHODS Data were collected in the Health-Related Quality of Life Study in Children with Epilepsy Study from 374 families of children with newly diagnosed epilepsy. The Quality of Life in Childhood Epilepsy (QOLCE) Questionnaire was used to evaluate parent-reported child HRQL. Hierarchical linear regression was used to examine the relationship between CSE and HRQL at 24 months postepilepsy. A total of 359 families completed the 24-month assessment. RESULTS Twenty-two children (6.1%) had experienced CSE during the follow-up. Children with and without CSE were similar, except a larger proportion of children with CSE had partial seizures (p < 0.001). Controlling for clinical, demographic, and family characteristics, CSE was significantly associated with poorer HRQL (β = -4.65, p = 0.031). The final model explained 47% of the variance in QOLCE scores. CONCLUSIONS The findings suggested that not only do children with CSE have significantly poorer HRQL compared with their non-CSE counterparts, but that this factor is independent of the effects of demographic and clinical features known to affect HRQL.
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Affiliation(s)
- Mark A Ferro
- From the Departments of Psychiatry & Behavioural Neurosciences (M.A.F.) and Pediatrics (M.A.F.), Offord Centre for Child Studies (M.A.F.), and CanChild Centre for Child Disability Research (M.A.F.), McMaster University, Hamilton, Canada; Muir Maxwell Epilepsy Centre (R.F.M.C.), The University of Edinburgh; Paediatric Neurosciences (R.F.M.C.), Royal Hospital for Sick Children (Edinburgh), UK; Child Neurology (C.S.C.), IWK Health Centre, Department of Paediatrics, Dalhousie University, Halifax; Department of Clinical Neuroscience (S.W.), University of Calgary; Departments of Paediatrics (S.D.L., K.N.S.) and Epidemiology & Biostatistics (K.N.S.), Western University, London, ON; and Children's Health Research Institute (S.D.L., K.N.S.), Lawson Health Research Institute, London, ON, Canada.
| | - Richard F M Chin
- From the Departments of Psychiatry & Behavioural Neurosciences (M.A.F.) and Pediatrics (M.A.F.), Offord Centre for Child Studies (M.A.F.), and CanChild Centre for Child Disability Research (M.A.F.), McMaster University, Hamilton, Canada; Muir Maxwell Epilepsy Centre (R.F.M.C.), The University of Edinburgh; Paediatric Neurosciences (R.F.M.C.), Royal Hospital for Sick Children (Edinburgh), UK; Child Neurology (C.S.C.), IWK Health Centre, Department of Paediatrics, Dalhousie University, Halifax; Department of Clinical Neuroscience (S.W.), University of Calgary; Departments of Paediatrics (S.D.L., K.N.S.) and Epidemiology & Biostatistics (K.N.S.), Western University, London, ON; and Children's Health Research Institute (S.D.L., K.N.S.), Lawson Health Research Institute, London, ON, Canada
| | - Carol S Camfield
- From the Departments of Psychiatry & Behavioural Neurosciences (M.A.F.) and Pediatrics (M.A.F.), Offord Centre for Child Studies (M.A.F.), and CanChild Centre for Child Disability Research (M.A.F.), McMaster University, Hamilton, Canada; Muir Maxwell Epilepsy Centre (R.F.M.C.), The University of Edinburgh; Paediatric Neurosciences (R.F.M.C.), Royal Hospital for Sick Children (Edinburgh), UK; Child Neurology (C.S.C.), IWK Health Centre, Department of Paediatrics, Dalhousie University, Halifax; Department of Clinical Neuroscience (S.W.), University of Calgary; Departments of Paediatrics (S.D.L., K.N.S.) and Epidemiology & Biostatistics (K.N.S.), Western University, London, ON; and Children's Health Research Institute (S.D.L., K.N.S.), Lawson Health Research Institute, London, ON, Canada
| | - Samuel Wiebe
- From the Departments of Psychiatry & Behavioural Neurosciences (M.A.F.) and Pediatrics (M.A.F.), Offord Centre for Child Studies (M.A.F.), and CanChild Centre for Child Disability Research (M.A.F.), McMaster University, Hamilton, Canada; Muir Maxwell Epilepsy Centre (R.F.M.C.), The University of Edinburgh; Paediatric Neurosciences (R.F.M.C.), Royal Hospital for Sick Children (Edinburgh), UK; Child Neurology (C.S.C.), IWK Health Centre, Department of Paediatrics, Dalhousie University, Halifax; Department of Clinical Neuroscience (S.W.), University of Calgary; Departments of Paediatrics (S.D.L., K.N.S.) and Epidemiology & Biostatistics (K.N.S.), Western University, London, ON; and Children's Health Research Institute (S.D.L., K.N.S.), Lawson Health Research Institute, London, ON, Canada
| | - Simon D Levin
- From the Departments of Psychiatry & Behavioural Neurosciences (M.A.F.) and Pediatrics (M.A.F.), Offord Centre for Child Studies (M.A.F.), and CanChild Centre for Child Disability Research (M.A.F.), McMaster University, Hamilton, Canada; Muir Maxwell Epilepsy Centre (R.F.M.C.), The University of Edinburgh; Paediatric Neurosciences (R.F.M.C.), Royal Hospital for Sick Children (Edinburgh), UK; Child Neurology (C.S.C.), IWK Health Centre, Department of Paediatrics, Dalhousie University, Halifax; Department of Clinical Neuroscience (S.W.), University of Calgary; Departments of Paediatrics (S.D.L., K.N.S.) and Epidemiology & Biostatistics (K.N.S.), Western University, London, ON; and Children's Health Research Institute (S.D.L., K.N.S.), Lawson Health Research Institute, London, ON, Canada
| | - Kathy N Speechley
- From the Departments of Psychiatry & Behavioural Neurosciences (M.A.F.) and Pediatrics (M.A.F.), Offord Centre for Child Studies (M.A.F.), and CanChild Centre for Child Disability Research (M.A.F.), McMaster University, Hamilton, Canada; Muir Maxwell Epilepsy Centre (R.F.M.C.), The University of Edinburgh; Paediatric Neurosciences (R.F.M.C.), Royal Hospital for Sick Children (Edinburgh), UK; Child Neurology (C.S.C.), IWK Health Centre, Department of Paediatrics, Dalhousie University, Halifax; Department of Clinical Neuroscience (S.W.), University of Calgary; Departments of Paediatrics (S.D.L., K.N.S.) and Epidemiology & Biostatistics (K.N.S.), Western University, London, ON; and Children's Health Research Institute (S.D.L., K.N.S.), Lawson Health Research Institute, London, ON, Canada
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Verrotti A, Carrozzino D, Milioni M, Minna M, Fulcheri M. Epilepsy and its main psychiatric comorbidities in adults and children. J Neurol Sci 2014; 343:23-9. [PMID: 24929650 DOI: 10.1016/j.jns.2014.05.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/08/2014] [Accepted: 05/19/2014] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders seem to be more frequent in patients with epilepsy (PWE) than the general population. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. According to this, psychiatric diseases are often underdiagnosed and undertreated in PWE with further decrease of the quality of life of patients. The aim of the review was to examine the most frequent psychiatric comorbidities in adults with epilepsy (AWE) and the main psychiatric comorbidities in children with epilepsy (CWE) in order to better understand the relationship between epilepsy and the development of psychiatric disorders.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy.
| | - Danilo Carrozzino
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Maddalena Milioni
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy
| | - Maria Minna
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Mario Fulcheri
- Department of Psychological, Humanistic and Territorial Sciences, University "G. D'Annunzio" of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
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23
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Rossi MA. Improving patient-centered care coordination for children with epilepsy: version 2.0 upgrade required. Epilepsy Curr 2014; 14:145-6. [PMID: 24940160 PMCID: PMC4038281 DOI: 10.5698/1535-7597-14.3.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Poduri A, Sheidley BR, Shostak S, Ottman R. Genetic testing in the epilepsies-developments and dilemmas. Nat Rev Neurol 2014; 10:293-9. [PMID: 24733164 PMCID: PMC4090104 DOI: 10.1038/nrneurol.2014.60] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In the past two decades, the number of genes recognized to have a role in the epilepsies has dramatically increased. The availability of testing for epilepsy-related genes is potentially helpful for clarification of the diagnosis and prognosis, selection of optimal treatments, and provision of information for family planning. For some patients, identification of a specific genetic cause of their epilepsy has important personal value, even in the absence of clear clinical utility. The availability of genetic testing also raises new issues that have only begun to be considered. These issues include the growing importance of educating physicians about when and how to test patients, the need to ensure that affected individuals and their families can make informed choices about testing and receive support after receiving the results, and the question of what the positive and negative consequences of genetic testing will be for affected individuals, their family members, and society.
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Affiliation(s)
- Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Beth Rosen Sheidley
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Sara Shostak
- Department of Sociology, Brandeis University, 415 South Street, Waltham, MA 02454, USA
| | - Ruth Ottman
- Gertrude H. Sergievsky Center and Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, 630 West 168th Street, New York, NY 10032, USA
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25
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Byars AW, deGrauw TJ, Johnson CS, Perkins SM, Fastenau PS, Dunn DW, Austin JK. Language and social functioning in children and adolescents with epilepsy. Epilepsy Behav 2014; 31:167-71. [PMID: 24434307 PMCID: PMC4527048 DOI: 10.1016/j.yebeh.2013.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/01/2013] [Accepted: 11/09/2013] [Indexed: 10/25/2022]
Abstract
Individuals with epilepsy have difficulties with social function that are not adequately accounted for by seizure severity or frequency. This study examined the relationship between language ability and social functioning in 193 children with epilepsy over a period of 36months following their first recognized seizure. The findings show that children with persistent seizures have poorer language function, even at the onset of their seizures, than do their healthy siblings, children with no recurrent seizures, and children with recurrent but not persistent seizures. They continue to demonstrate poorer language function 36months later. This poor language function is associated with declining social competence. Intervention aimed at improving social competence should include consideration of potential language deficits that accompany epilepsy and social difficulty.
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Affiliation(s)
- Anna W. Byars
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, USA,Corresponding author at: Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2015, Cincinnati, Ohio 45229, USA. Fax: +1 513 636 1888. (A.W. Byars)
| | - Ton J. deGrauw
- Children's Health Care of Atlanta, Emory University School of Medicine, USA
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Wagner JL, Smith G, Ferguson PL, Fedele DA. Preliminary Psychometrics of the Neurological Disorders Depression Inventory for Epilepsy-Youth. J Child Neurol 2013; 28:1392-1399. [PMID: 23576412 DOI: 10.1177/0883073813483367] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors examined the preliminary psychometrics of a depression screening tool for youth with epilepsy. Development involved content analysis, cognitive interviewing, and qualitative analysis. Ninety-three youths with epilepsy aged 10 to 17 years completed the Neurological Disorders Depression Inventory for Epilepsy-Youth and the depression module of a standardized clinical interview. Caregivers rated seizure severity and completed the Pediatric Symptom Checklist. Results indicated strong reliability indices, including test-retest, κ value, and internal consistency for the Neurological Disorders Depression Inventory for Epilepsy-Youth. It was significantly associated with the other measures of depression and psychosocial functioning. Factor analyses revealed a 1-factor solution for 9 items, with 35.7% of the variance explained. An optimal cutoff score of 27 resulted in a sensitivity index of 0.80 and a specificity index of 0.71. The Neurological Disorders Depression Inventory for Epilepsy-Youth is a screening tool that can be utilized in routine epilepsy care, but further evaluation is necessary.
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Affiliation(s)
- Janelle L Wagner
- 1College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Ferro MA, Camfield CS, Levin SD, Smith ML, Wiebe S, Zou G, Speechley KN. Trajectories of health-related quality of life in children with epilepsy: a cohort study. Epilepsia 2013; 54:1889-97. [PMID: 24116691 DOI: 10.1111/epi.12388] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE Little is known about subgroups of children with epilepsy who may experience less favorable outcomes over time. The objectives of this study were to document trajectories of health-related quality of life (HRQL) and to identify predictors of the trajectory group in children with new-onset epilepsy. METHODS Data were obtained from the Health Related Quality of Life in Children with Epilepsy Study, a prospective multisite study of children 4-12 years old with new-onset epilepsy followed for 24 months. Health-related quality of life was measured using the Quality of Life in Childhood Epilepsy questionnaire. Trajectories of HRQL were investigated using latent class trajectory modeling. Multinomial logistic regression was used to identify child, parent, and family predictors of HRQL trajectories. KEY FINDINGS A total of 374 families responded at baseline and 283 (76%) completed the study. Five HRQL trajectories were observed: low-increasing (4%), moderate-decreasing (12%), moderate-increasing (22%), high-increasing (32%), and high-stable (30%). Many children in the low-increasing, moderate-increasing, high-increasing, and high-stable had clinically meaningful improvements in HRQL: 82%, 47%, 63%, and 44%, respectively. In contrast, the majority of children in the moderate-decreasing group (56%) experienced clinically meaningful declines in their HRQL. Factors predicting trajectories were number of antiepileptic drugs prescribed, presence of comorbid behavior or cognitive problems, parent depression, and family functioning and demands. SIGNIFICANCE Results suggested that children with epilepsy are not homogenous but rather consist of groups with different trajectories and unique predictors of HRQL. Problems associated with child behavior and cognition were the strongest predictors identified. Given that several risk factors are modifiable, it is important to examine these as potential targets within a family-centered framework to improve HRQL of children with new-onset epilepsy.
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Affiliation(s)
- Mark A Ferro
- Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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Ferro MA, Landgraf JM, Speechley KN. Factor structure of the Child Health Questionnaire Parent Form-50 and predictors of health-related quality of life in children with epilepsy. Qual Life Res 2013; 22:2201-11. [PMID: 23334980 DOI: 10.1007/s11136-013-0351-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE The present study investigated the higher-order summary factor structure of the Child Health Questionnaire Parent Form-50 (CHQ) in a sample of children with new-onset epilepsy. The secondary aim was to identify risk factors predicting health-related quality of life (HRQL) 24 months post-diagnosis. METHODS Data came from the Health-related Quality of Life in Children with Epilepsy Study (HERQULES, N = 374), a multi-site study documenting HRQL among children with epilepsy from diagnosis through 24 months. Confirmatory factor analysis was used to determine goodness of fit between the original structure of the CHQ and HERQULES data. Multiple regression was used to identify risk factors at diagnosis for HRQL at 24 months. RESULTS The models demonstrated good fit: baseline: CFI = 0.945; TLI = 0.941; WRMR = 1.461; RMSEA = 0.058; 24 months: CFI = 0.957; TLI = 0.954; WRMR = 1.393; RMSEA = 0.055. Factor loadings were high and no cross-loadings observed (first order: λ = 0.27-0.99, 0.24-0.98; second order: λ = 0.69-0.86, 0.54-0.92; p < 0.001 for all). Controlling for HRQL at diagnosis, predictors for better 24-month HRQL were as follows: physical health: fewer cognitive problems (p = 0.023) and parents with fewer depressive symptoms (p = 0.049); psychosocial health: older parent age (p = 0.043), fewer behavior problems (p = 0.004), and families with better functioning (p = 0.008) and fewer demands (p = 0.009). CONCLUSIONS The CHQ higher-order summary factor structure was replicated in a sample of children with new-onset epilepsy, and child and family risk factors at diagnosis were found to predict HRQL 24 months post-diagnosis. These findings suggest it is possible to identify at-risk children early in the illness process and provide impetus for adopting family-centered care practices.
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Affiliation(s)
- Mark A Ferro
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Chedoke Site, Central Building, Room 310, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada,
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Caplan R. Psychopathology in pediatric epilepsy: role of antiepileptic drugs. Front Neurol 2012; 3:163. [PMID: 23233847 PMCID: PMC3516700 DOI: 10.3389/fneur.2012.00163] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 10/24/2012] [Indexed: 01/17/2023] Open
Abstract
Children with epilepsy are usually treated with antiepileptic drugs (AEDS). Some AEDs adversely affect behavior in susceptible children. Since psychiatric comorbidity is prevalent in pediatric epilepsy, this paper attempts to disentangle these AED side effects from the psychopathology associated with this illness. It first outlines the clinical and methodological problems involved in determining if AEDs contribute to the behavior and emotional problems of children with epilepsy. It then presents research evidence for and against the role AEDs play in the psychopathology of children with epilepsy, and outlines how future studies might investigate this problem. A brief description of how to clinically separate out AED effects from the complex illness-related and psychosocial factors that contribute to the behavior difficulties of children with epilepsy concludes the paper.
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Affiliation(s)
- Rochelle Caplan
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles Los Angeles, CA, USA
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Speechley KN, Ferro MA, Camfield CS, Huang W, Levin SD, Smith ML, Wiebe S, Zou G. Quality of life in children with new-onset epilepsy: a 2-year prospective cohort study. Neurology 2012; 79:1548-55. [PMID: 23019268 DOI: 10.1212/wnl.0b013e31826e25aa] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess health-related quality of life (HRQL) over 2 years in children 4-12 years old with new-onset epilepsy and risk factors. METHODS Data are from a multicenter prospective cohort study, the Health-Related Quality of Life Study in Children with Epilepsy Study (HERQULES). Parents reported on children's HRQL and family factors and neurologists on clinical characteristics 4 times. Mean subscale and summary scores were computed for HRQL. Individual growth curve models identified trajectories of change in HRQL scores. Multiple regression identified baseline risk factors for HRQL 2 years later. RESULTS A total of 374 (82) questionnaires were returned postdiagnosis and 283 (62%) of eligible parents completed all 4. Growth rates for HRQL summary scores were most rapid during the first 6 months and then stabilized. About one-half experienced clinically meaningful improvements in HRQL, one-third maintained their same level, and one-fifth declined. Compared with the general population, at 2 years our sample scored significantly lower on one-third of CHQ subscales and the psychosocial summary. After controlling for baseline HRQL, cognitive problems, poor family functioning, and high family demands were risk factors for poor HRQL 2 years later. CONCLUSIONS On average, HRQL was relatively good but with highly variable individual trajectories. At least one-half did not experience clinically meaningful improvements or declined over 2 years. Cognitive problems were the strongest risk factor for compromised HRQL 2 years after diagnosis and may be largely responsible for declines in the HRQL of children newly diagnosed with epilepsy.
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Self-efficacy for seizure management and youth depressive symptoms: Caregiver and youth perspectives. Seizure 2012; 21:334-9. [DOI: 10.1016/j.seizure.2012.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 11/22/2022] Open
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Wagner JL, Ferguson PL, Smith G. The relationship of coping behaviors to depressive symptoms in youth with epilepsy: an examination of caregiver and youth proxy report. Epilepsy Behav 2012; 24:86-92. [PMID: 22481037 DOI: 10.1016/j.yebeh.2012.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 01/26/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
Abstract
Study aims were to explore evaluation and comparison of measures of coping and the relationship of epilepsy-specific coping responses to depressive symptoms in youth with epilepsy (YWE). Seventy-six YWE ages 9-17 completed the Children's Depression Inventory (CDI) and the Kidcope. Sixty-six caregivers reported on youth coping (CHIC) and seizure activity. Epilepsy variables were abstracted from electronic medical records. There were no significant correlations between the CHIC coping factors and individual Kidcope scores. Only one CHIC factor, "competence/optimism," was significantly negatively correlated with CDI. Regression analyses revealed a significant association between CDI and negative coping (Kidcope) after adjusting for sex, number of AEDs, and seizure severity. On the CDI, 27% of YWE endorsed suicidal ideation. Findings provide preliminary support for use of the Kidcope as a measure of negative epilepsy-specific coping. These results imply that youth coping and suicidal ideation are important to assess in relation to depressive symptoms and that youth report of these symptoms is particularly salient to the evaluation of youth functioning.
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Affiliation(s)
- Janelle L Wagner
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425, USA.
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Abstract
OBJECTIVE To determine sociodemographics, patterns of comorbidity, and function of US children with reported epilepsy/seizure disorder. METHODS Bivariate and multivariable cross-sectional analysis of data from the National Survey of Children's Health (2007) on 91 605 children ages birth to 17 years, including 977 children reported by their parents to have been diagnosed with epilepsy/seizure disorder. RESULTS Estimated lifetime prevalence of epilepsy/seizure disorder was 10.2/1000 (95% confidence interval [CI]: 8.7-11.8) or 1%, and of current reported epilepsy/seizure disorder was 6.3/1000 (95% CI: 4.9-7.8). Epilepsy/seizure disorder prevalence was higher in lower-income families and in older, male children. Children with current reported epilepsy/seizure disorder were significantly more likely than those never diagnosed to experience depression (8% vs 2%), anxiety (17% vs 3%), attention-deficit/hyperactivity disorder (23% vs 6%), conduct problems (16% vs 3%), developmental delay (51% vs 3%), autism/autism spectrum disorder (16% vs 1%), and headaches (14% vs 5%) (all P < .05). They had greater risk of limitation in ability to do things (relative risk: 9.22; 95% CI: 7.56-11.24), repeating a school grade (relative risk: 2.59; CI: 1.52-4.40), poorer social competence and greater parent aggravation, and were at increased risk of having unmet medical and mental health needs. Children with prior but not current seizures largely had intermediate risk. CONCLUSIONS In a nationally representative sample, children with seizures were at increased risk for mental health, developmental, and physical comorbidities, increasing needs for care coordination and specialized services. Children with reported prior but not current seizures need further study to establish reasons for their higher than expected levels of reported functional limitations.
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Affiliation(s)
- Shirley A Russ
- Department of Academic Primary Care Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Epilepsy, mental health disorder, or both? EPILEPSY RESEARCH AND TREATMENT 2011; 2012:163731. [PMID: 22934158 PMCID: PMC3420407 DOI: 10.1155/2012/163731] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/02/2011] [Indexed: 01/28/2023]
Abstract
Temporal lobe epilepsy (TLE), a subset of the seizure disorder family, represents a complex neuropsychiatric illness, where the neurological presentation may be complemented by varying severity of affective, behavioral, psychotic, or personality abnormalities, which, in turn, may not only lead to misdiagnosis, but also affect the management. This paper outlines a spectrum of mental health presentations, including psychosis, mood, anxiety, panic, and dissociative states, associated with epilepsy that make the correct diagnosis a challenge.
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Abstract
This paper first summarizes the main findings of clinical studies conducted over the past two and a half decades on psychopathology (i.e., psychiatric diagnoses, behavior and emotional problems) in children with new onset and chronic epilepsy both with and without intellectual disability who are treated medically and surgically. Although impaired social relationships are core features of the psychiatric disorders found in pediatric epilepsy, few studies have examined social competence (i.e., social behavior, social adjustment, and social cognition) in these children. There also is a dearth of treatment studies on the frequent psychiatric comorbidities of pediatric epilepsy, attention deficit hyperactivity disorder, anxiety disorders, and depression. Drs. Hamiwka and Jones then describe their current and planned studies on social competence and cognitive behavioral treatment of anxiety disorders, respectively, in these children and how they might mitigate the poor long-term psychiatric and social outcome of pediatric epilepsy.
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Affiliation(s)
- Lorie Hamiwka
- Division of Child Neurology, Ohio State University College of Medicine, Columbus, OH, USA
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Austin JK, Perkins SM, Johnson CS, Fastenau PS, Byars AW, deGrauw TJ, Dunn DW. Behavior problems in children at time of first recognized seizure and changes over the following 3 years. Epilepsy Behav 2011; 21:373-81. [PMID: 21727031 PMCID: PMC3182400 DOI: 10.1016/j.yebeh.2011.05.028] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 05/20/2011] [Accepted: 05/24/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purposes of this 36-month study of children with first recognized seizures were: (1) to describe baseline differences in behavior problems between children with and without prior unrecognized seizures; (2) to identify differences over time in behavior problems between children with seizures and their healthy siblings; (3) to identify the proportions of children with seizures and healthy siblings who were consistently at risk for behavior problems for 36 months; and (4) to identify risk factors for behavior problems 36 months following the first recognized seizure. Risk factors explored included demographic (child age and gender, caregiver education), neuropsychological (IQ, processing speed), seizure (epileptic syndrome, use of antiepileptic drug, seizure recurrence), and family (family mastery, satisfaction with family relationships, parent response) variables. METHODS Participants were 300 children aged 6 through 14 years with a first recognized seizure and 196 healthy siblings. Data were collected from medical records, structured interviews, self-report questionnaires, and neuropsychological testing. Behavior problems were measured using the Child Behavior Checklist and the Teacher's Report Form. Data analyses included descriptive statistics and linear mixed models. RESULTS Children with prior unrecognized seizures were at higher risk for behavior problems at baseline. As a group, children with seizures showed a steady reduction in behavior problems over time. Children with seizures were found to have significantly more behavior problems than their siblings over time, and significantly more children with seizures (11.3%) than siblings (4.6%) had consistent behavior problems over time. Key risk factors for child behavior problems based on both caregivers and teachers were: less caregiver education, slower initial processing speed, slowing of processing speed over the first 36 months, and a number of family variables including lower levels of family mastery or child satisfaction with family relationships, lower parent support of the child's autonomy, and lower parent confidence in their ability to discipline their child. CONCLUSIONS Children with new-onset seizures who are otherwise developing normally have higher rates of behavior problems than their healthy siblings; however, behavior problems are not consistently in the at-risk range in most children during the first 3 years after seizure onset. When children show behavior problems, family variables that might be targeted include family mastery, parent support of child autonomy, and parents' confidence in their ability to handle their children's behavior.
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Affiliation(s)
- J. K. Austin
- Department of Environments for Health, Indiana University School of Nursing
| | - S. M. Perkins
- Division of Biostatistics, Department of Medicine, Indiana University School of Medicine
| | - C. S. Johnson
- Division of Biostatistics, Department of Medicine, Indiana University School of Medicine
| | - P. S. Fastenau
- Department of Neurology, University Hospitals Case Medical Center and Case Western Reserve University School of Medicine
| | - A. W. Byars
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center & University of Cincinnati College of Medicine
| | - T. J. deGrauw
- Department of Neurology, Cincinnati Children’s Hospital Medical Center & University of Cincinnati College of Medicine
| | - D. W. Dunn
- Departments of Psychiatry and Neurology, Indiana University School of Medicine
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Hoppe C, Elger CE. Depression in epilepsy: a critical review from a clinical perspective. Nat Rev Neurol 2011; 7:462-72. [PMID: 21750525 DOI: 10.1038/nrneurol.2011.104] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dunn DW, Johnson CS, Perkins SM, Fastenau PS, Byars AW, deGrauw TJ, Austin JK. Academic problems in children with seizures: relationships with neuropsychological functioning and family variables during the 3 years after onset. Epilepsy Behav 2010; 19:455-61. [PMID: 20888303 DOI: 10.1016/j.yebeh.2010.08.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 08/20/2010] [Accepted: 08/24/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Children with long-standing epilepsy have a significantly increased risk of academic underachievement compared with healthy controls. We prospectively followed children from seizure onset to assess the relationship between change in neuropsychological functioning and change in academic achievement and to explore the risk and protective moderating effects of demographic, seizure, and family variables. METHODS As part of a larger study, neuropsychological and academic data were collected at both baseline and 36 months for 219 children 6-14 years of age with seizures. Prior factor analysis of results from a battery of well-standardized neuropsychological tests yielded four factors: language, processing speed, attention/executive/construction, and verbal memory/learning. Academic achievement was measured with the Woodcock-Johnson Revised Achievement Test Battery. Correlation coefficients and linear mixed models were used for analysis. RESULTS The reading and math scores of children with seizures and siblings did not differ at baseline, but children with seizures had lower scores than siblings at 36 months. Writing scores were significantly lower for affected children than siblings at both times. Among children with seizures, there were positive correlations between neuropsychological functioning and academic achievement at baseline and 36 months. Changes in language and in verbal memory/learning were positively correlated with change in reading achievement (r = 0.25 and r = 0.17, respectively). Age at onset moderated the association between change in neuropsychological functioning and change in reading and writing achievement (P ≤ 0.006), with stronger relationships among younger children (β = 0.25-0.44). The association between change in language and change in writing achievement was moderated by caregiver anxiety (P = 0.04; stronger for more anxious parents, β = 0.40), and the association between change in processing speed and change in math achievement was moderated by etiology (P = 0.02; stronger for symptomatic/cryptogenic vs idiopathic, β = 0.29). Gender and other family variables did not have significant moderating effects. CONCLUSIONS Changes in neuropsychological function were associated with changes in academic achievement following onset of seizures, with risk factors being younger age at onset, lower caregiver education, high parental anxiety, and symptomatic/cryptogenic etiology. Academic performance should be closely monitored in children with early-onset seizures.
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Affiliation(s)
- David W Dunn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
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