Does academic achievement in children with epilepsy change over time?

A 4-year follow-up study of academic achievement in children aged between 11 and 17 years with epilepsy or asthma was carried out to identify differences between the two samples and to identify change in achievement over time. Differences based on sex and seizure severity also were explored. There were 98 subjects in the group with epilepsy and 96 subjects in the group with asthma. Academic achievement in five areas (Composite, Reading, Mathematics, Language, and Vocabulary) was measured using school-administered group test scores. To explore change over time in condition severity, each child was categorized as having a low or high condition severity at baseline (time I) and again 4 years later, resulting in four groups: low-low, low-high, high-low, and high-high. There were too few cases in the low-high group to be included in the analyses. Data were processed using analysis of covariance (ANCOVA), intraclass correlation coefficients, and paired t tests. At follow-up the children with epilepsy continued to perform significantly worse in all five achievement areas than the children with asthma. Children with either inactive or low-severity epilepsy had mean scores comparable to national norms; those with high seizure severity had mean scores ranging from 3 to 5 points below national norms. No changes were found in academic achievement over time for either sample, even among those whose conditions improved. Although boys with high-severity epilepsy continued to have the lowest achievement scores, there was no trend for them to decline in achievement over time.     

Perceived impact of childhood-onset epilepsy on quality of life as an adult

Summary:  Purpose: Childhood-onset epilepsy is a common disorder. The long-term impact of having childhood epilepsy on quality of life (QOL) as an adult, whether or not seizures are in remission, has not been systematically studied.
Methods: A population-based cohort of 245 children younger than 16 years with active epilepsy between 1961 and 1964 residing in the catchment area of Turku University Hospital was followed up prospectively until 1997. Of the 99 surviving cases with uncomplicated epilepsy and 99 matched population controls, 91 subjects and controls completed questionnaires on QOL and psychosocial outcomes.
Results: Of the 91 subjects, 61 (67%) were in remission off medication, 13 (14%) in remission on medications, and 17 (19%) were not in remission. Subjects on medication, whether in remission or not, had worse scores on both general measures of QOL and epilepsy-specific measures than did either controls or subjects in remission off medications. They also had significantly higher rates of unemployment (p < 0.001) and lower socioeconomic status. These differences could not be accounted for by differences in education or seizure frequency. Subjects in remission off medication had rates of employment and socioeconomic status similar to those of controls. All subjects, regardless of remission status, had lower rates of marriage and of having children than did controls (p < 0.001).
Conclusions: Childhood-onset epilepsy has a persistent long-term adverse impact on health-related quality of life. The major impact is on those still on medications as adults, whether or not they are in remission. The impact on those in remission off medications is relatively modest.     

Impact of anxiety and depression on functional impairment in adolescents with asthma

OBJECTIVE: This study aimed to assess the association of anxiety and depression with psychosocial and asthma-related functional impairment in a large-population-based sample of adolescents with asthma. METHOD: The sample consisted of 767 youths ages 11 to 17 with a documented diagnosis of, and active treatment for, asthma. Telephone interviews were completed with each youth and one parent to assess asthma-related symptoms and self-report of psychosocial and asthma-related functional status. Structured diagnostic interviews (Computerized Diagnostic Interview Schedule for Children) were administered to determine psychiatric diagnoses. Weighted multiple linear regression models were employed to identify variables that were independently and significantly associated with levels of functioning. RESULTS: One hundred twenty-five youths (16.2%) met DSM-IV criteria for one or more anxiety and depressive disorders in the last 12 months. After controlling for demographic variables, greater severity of self-reported depressive and anxiety symptoms and presence of one or more DSM-IV anxiety or depressive diagnosis were associated with psychosocial and asthma-related functional status. The mental health factors were more strongly associated with measures of asthma and psychological functional outcomes than the modified Health Plan Employer Data and Information Set asthma risk measure. CONCLUSIONS: Increased awareness of the need to assess and effectively treat psychiatric symptoms in youth with asthma may reduce the functional burden associated with asthma.     

Health-related quality of life in adolescents with epilepsy in Montenegro

ObjectiveThe objective of this study was to establish potential risk factors for poor health-related quality of life among adolescents with epilepsy in Montenegro.Material and methodsA sample of 104 adolescents with epilepsy (age: 11–19 years) at a tertiary referral center in Podgorica, Montenegro, completed the validated Serbian version of the QOLIE-AD-48 questionnaire. They were divided into two groups: a group with active epilepsy (60 adolescents) and a group with inactive epilepsy (44 adolescents). Demographic and clinical data were collected.ResultsAdolescents with active epilepsy had low quality of life and felt the negative impact of the disease. They also had more cognitive impairments, felt more stigmatized, and had considerably more distorted perception of their health than adolescents with inactive epilepsy (p < 0.05). Females reported better social support than males (p < 0.05). Older males had lower grades at school (p < 0.05) than the younger ones. As expected, adolescents with the highest number of seizures in the past two years had the lowest quality of life (p < 0.05).ConclusionIn our study, the quality of life in adolescents with epilepsy was determined by severity of the disease, age, and gender.     

Quality of Life (QOL) of patients with Gilles de la Tourette's syndrome

OBJECTIVE: This is the first study to investigate the Quality of Life (QOL) of patients with Gilles de la Tourette's Syndrome (GTS). METHOD: One hundred and three out-patients with GTS completed a semi-structured interview and 90 of these completed questionnaires screening for depression, anxiety and obsessive-compulsive behaviour. QOL was measured with the SF-36 and the Quality of Life Assessment Schedule (QOLAS). RESULTS: Patients with GTS showed significantly worse QOL than a general population sample. They had better QOL than patients with intractable epilepsy as measured by the QOLAS, although the SF-36 showed significant differences on the subscales Role Limitation due to physical problems and Social Functioning only. Factors influencing QOL domains were employment status, tic severity, obsessive-compulsive behaviour, anxiety and depression. CONCLUSION: QOL is impaired in patients with GTS. Measurement of QOL could be used alongside conventional measurements to assess benefit of treatment. We recommend the QOLAS and SF-36 be used.     

Vagus Nerve Stimulation in 16 Children with Refractory Epilepsy

Summary: Purpose : Vagus nerve stimulation (VNS) has been reported to produce >90% reduction in the number of seizures in children with intractable epilepsy. These encouraging results need confirmation.
Methods : Sixteen children, 10 boys and 6 girls aged 4-19 years, were treated with VNS (Cyberonics, Webster, TX, U.S.A.) for 12-24 months. Seizure frequency, seizure severity, changes in quality of life (QOL: visual analogue scale), and side effects were recorded. Eight children had partial and 8 had generalized seizures; 4 of the latter had Lennox-Gastaut syndrome (LGS).
Results : During the tenth to twelfth month of VNS, 6 of 16 children experienced ≥50% reduction in seizure frequency. One girl became seizure-free. Seizure severity showed an average decrease in the score from 15 to 11. After 10 months of treatment, QOL was estimated to have improved ≥50% in 6 of 16 children. Reduction in seizure frequency, decreased seizure severity, and reported improvement in QOL did not entirely coincide. Six children experienced hoarseness, 1 had neck pain, 2 had hypersalivation, 2 experienced tiredness, 2 had aspiration episodes during liquid intake, and 6 had electrical transmission problems; in 4 the problem has been surgically corrected. Five stimulators were turned off due to lack of efficacy.
Conclusions : Six of 16 children with refractory epilepsy treated with VNS improved, with a reduction not only in seizure frequency but also in seizure severity and in QOL.     

Informant Agreement in Behavior Ratings for Children with Epilepsy

The purpose of this study was to determine the degree of informant agreement for behavioral ratings of children with epilepsy. Informants completed Achenbach's 1991 scales: parents completed the Child Behavior Checklist (CBCL), teachers completed the Teacher's Report Form (TRF), and youth completed the Youth Self-Report Form of the CBCL (YSR). Analyses included degree of concordance of ratings as a function of informant, child gender, and condition severity (active vs inactive epilepsy). Results indicated that across all four types of raters (mothers, fathers, teachers, and adolescents) there was a similar pattern. Mothers' ratings tended to be the highest and youths' ratings tended to be the lowest across scales. In general, agreement among adult raters was greater than between youth and adults. Mothers and teachers reported more internalizing symptoms than did youth; mother, father, and teacher ratings on externalizing symptoms were not significantly different from each other. There were no significant effects of gender and condition severity on concordance among ratings although there were some interesting trends.     

Symptoms of depression in adolescents with epilepsy.

OBJECTIVE: To identify factors related to symptoms of depression in a sample of adolescents with epilepsy. METHOD: Cross-sectional data were collected on 115 adolescents aged 12 to 16 years who had epilepsy. Demographic (age, gender), seizure (severity, age of onset), family (stress, resources, relationships), mother (perceptions of stigma, depression), and child (attitude toward epilepsy, satisfaction with family relationships, coping, perceptions of control) variables were assessed by questionnaire and standardized scales. Depression was measured by the Children's Depression Inventory and the Anxiety/Depression subscale of the Youth Self-Report. Data were analyzed by using multiple regression with depression as the dependent variable. RESULTS: In this sample, 23% of subjects had symptoms of depression. Significant predictors of depression as measured by the Children's Depression Inventory (R2 = 0.53) were youth's attitude toward epilepsy, youth satisfaction with family relationships, and unknown locus of control or external locus of control for socially powerful others. CONCLUSIONS: Adolescents' attitudes, attributions, and satisfaction with family relationships are related to depression and should be assessed in the clinical setting. The relationship between locus of control and depression fits the learned helplessness model of depression and suggests the need for interventions to promote an internal locus of control in adolescents with epilepsy.     

Caregiver perceptions of seizure severity in pediatric epilepsy

Purpose:  Seizure severity has been investigated using multiple tools over the years, and its defining features continue to be debated. Severity ratings are necessary for medical, psychological, and epidemiologic investigations. Adults with epilepsy have been evaluated more than youth with epilepsy.
Methods:  Seizure severity was evaluated as part of a larger study that included youth and caregiver self-report measures of the emotional and social variables that occur in epilepsy.
Results:  The results indicate that a longer recovery time from the last seizure and a longer duration of seizure influence how severe a caregiver judges seizures. The usual elements such as type of epilepsy, frequency of seizures, and most recent seizure were not significantly related to severity rating. Behavior ratings were also not related to severity rating.
Discussion:  Clinicians often rely heavily on caregiver information during clinic visits to help inform treatment decisions; therefore, a standard measure of seizure severity from the caregivers' perception has clinical utility. Rather than assuming what makes a seizure severe to a parent, more research should be conducted on what elements contribute to severity, as judged by both the parent and youth.     

Executive functioning in children with intractable frontal lobe or temporal lobe epilepsy

The aim of the present study was to shed light on the executive functioning deficits that might differentiate children with frontal lobe epilepsy (FLE) from children with temporal lobe epilepsy (TLE). Participants included 19 youth with intractable FLE and 47 youth with intractable TLE. Participants completed the Wisconsin Card Sorting Test (WCST), verbal fluency, Trail Making Test (Trails A and B), Digit Span Forward (DSF), and Digit Span Backward (DSB). When compared to the normative sample, the FLE group performed significantly worse on DSF, DSB, Trails B, and the WCST. Similarly, the TLE group performed significantly worse on DSF and DSB compared to the normative sample. Youth with FLE had significantly greater difficulty on the WCST compared to the TLE group. Overall, the results indicated that youth with FLE had significantly greater difficulty with concept formation compared to children with TLE. No differences between groups emerged on tasks assessing attention, working memory, mental flexibility, or rapid word retrieval. Both groups performed significantly below the normative sample levels on attention and working memory tasks. As a whole, it appears that some, although not all, executive dysfunction is specific to FLE.