Authors :
Presenting Author: Krishna Vamsi Rojulpote, MS – Loyola University Chicago Stritch School of Medicine
Mary Lou Smith, PhD, CPsych – Department of Psychology, Neurosciences and Mental Health Program – University of Toronto Mississauga, The Hospital for Sick Children; Klajdi Puka, PhD – Department of Epidemiology and Biostatistics – Western University; Kathy Speechley, PhD – Department of Pediatrics and Epidemiology and Biostatistics – Schulich School of Medicine and Dentistry, Western University; Mark Ferro, PhD – School of Public Health Sciences – University of Waterloo; Mary Connolly, MD – Division of Neurology, Department of Pediatrics – BC Children’s Hospital; Philippe Major, MD – Division of Neurology, Department of Neurosciences – CHU Ste-Justine Hospital, University of Montreal; Anne Gallagher, PhD – Centre de Recherche, CHU Ste-Justine Hospital, University of Montreal; Salah Almubarak, MD – Division of Pediatric Neurology – University of Saskatchewan, Qatif Central Hospital; Simona Hasal, MD – Division of Pediatric Neurology – University of Saskatchewan; Rajesh Ramachandrannair, MD – Department of Pediatrics – McMaster University; Andrea Andrade, MD – Department of Pediatrics – Schulich School of Medicine and Dentistry, Western University; Qi Xu, MD – Department of Pediatrics and Child Health – University of Manitoba; Edward Leung, MD – Department of Pediatrics and Child Health – University of Manitoba; O. Carter Snead, MD – Division of Neurology – The Hospital for Sick Children; Elysa Widjaja, MD, PhD – Neurosciences and Mental Health Program, Department of Medical Imaging – The Hospital for Sick Children, Lurie Children's Hospital
Rationale:
Seizure freedom is an important predictor of health-related quality of life (HRQOL) after epilepsy surgery in children with drug-resistant epilepsy (DRE). Still, the baseline predictors of HRQOL after surgery are not known. This study aimed to identify the baseline predictors of HRQOL two years after epilepsy surgery in children with DRE.
Methods:
This study used a subset of data from the Impact of Pediatric Epilepsy Surgery on Health-Related Quality of Life (PEPSQOL) study, a multicenter prospective cohort study. Predictors assessed at baseline before surgery included child characteristics such as demographics and clinical variables, caregiver characteristics including caregiver depressive and anxiety symptoms, and family characteristics. HRQOL was assessed using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55, a parent-reported epilepsy-specific instrument, at baseline and two years after surgery. Univariable linear regression analyses were done to identify significant predictors of HRQOL at the two year follow-up, followed by a multivariable regression analysis.
Results:
Ninety-five children underwent epilepsy surgery; the mean age was 11.4 ± 4.2 years, and 59 (62%) were male. The mean QOLCE scores were 57.4 (95% CI: 53.8, 61.0) at baseline and 65.6 (95% CI: 62.0, 69.1) two years after surgery. Univariable regression analyses showed that fewer anti-seizure medications (ß = -6.1 [95% CI: -11.2, -1.0], p=0.019), older age at seizure onset (ß = 1.6 [95% CI: 0.8, 2.4], p< 0.001), higher baseline QOLCE scores (ß = 0.7 [95% CI: 0.5, 0.8], p< 0.001), higher resources (ß = 0.6 [95% CI: 0.3, 0.9], p< 0.001), better family relationships (ß = 1.7 [95% CI: 0.3, 3.1], p=0.017) and lower family demands (ß = -0.9 [95% CI: -1.5, -0.4], p< 0.001) were associated with higher HRQOL two years after surgery. Caregiver characteristics did not predict HRQOL two years after surgery (p >0.05). Multivariable regression analysis showed that older age at seizure onset (ß = 1.1, [95% CI: 0.5, 1.8], p=0.001) and higher baseline QOLCE scores (ß = 0.6, 95% CI: (0.4, 0.7), p< 0.001) were associated with higher HRQOL two years after surgery.