Abstracts

RATIONALE: Previous comparisons between the epilepsy syndromes focus narrowly on behavioural or psychiatric domains of health-related quality of life (HRQOL) and achieve conflicting results (Neurology 1999;53suppl 2:S13-S25). It is critical to examine differences using a broader measure of HRQOL. We aim to do this using a multi-dimensional validated tool, specific for children with epilepsy (Quality of Life in Childhood Epilepsy questionnaire, QOLCE). This measure was constructed in our Unit and is published (Epilepsia 2000;41:765-74).
METHODS: Parents of 83 children with intractable epilepsy (47 females; aged 4-18 years; IQ[gt]70) completed the QOLCE and were asked to indicate on a 6-point scale the severity of their child[scquote]s seizures during the last six months (no seizures, very mild, mild, moderate, severe, very severe). Epilepsy syndrome was defined according to the International League Against Epilepsy (ILAE) classification using ictal recording on video-EEG. Syndromes were classified as: generalised symptomatic (GEN-SYM) or idiopathic (GEN-IDIO), frontal (FLE), temporal (TLE) or parietal/occipital (POLE) lobe epilepsy. A focal epilepsy that could not be localised was classified PARTIAL. All children had their age of epilepsy onset and number of antiepileptic drugs (AEDs) recorded. The syndrome groups were analysed for differences in age, age of onset, AEDs and seizure severity using analysis of variance. Variables where groups differed were included in further analyses as covariates. Analysis of variance and covariance was used to determine if the syndrome groups differed on any of the 16 QOLCE subscales. Significance was determined at the 0.01 level to control for multiple comparisons.
RESULTS: Fifteen children had TLE, 18 FLE, 8 POLE, 16 PARTIAL, 2 GEN-SYM and 24 GEN-IDIO. The GEN-SYM group was excluded from analyses because of small numbers. The groups did not differ in terms of age, age of onset or AEDs (p[gt]0.05). However, the syndrome groups did differ in terms of seizure severity (p[lt]0.01). Children with GEN-IDIO had the least severe seizures followed by, in order of severity, TLE, PARTIAL, FLE and POLE. Post-hoc analyses showed that children with POLE were rated as having more severe seizures compared to children with GEN-IDIO (p[lt]0.01). No other post-hoc analyses were significant. Initial analysis of the HRQOL features of specific epilepsy syndromes indicated there were significant differences between groups. These results failed to remain significant when seizure severity was included in the analysis as a covariate.
CONCLUSIONS: The results indicate that variation in seizure severity rather than specific epilepsy syndromes influence the quality of a child[scquote]s life. Seizure control through medication or surgery is critical.
Support: National Health & Medical Resarch Council (NHMRC), Sydney Children[ssquote]s Hospital Foundation, Australian Brain Foundation and Rothschild Australia.