Abstracts

Rationale: Health-related quality of life (HRQL) is an important outcome in understanding the course of illness and effects of treatment in children with epilepsy. Findings from previous studies examining the association between clinical factors and HRQL in childhood epilepsy have been inconsistent. Such discrepant findings may be attributable to the failure to account for the heterogeneity of comorbidities affecting children with epilepsy. Thus, in children with newly-diagnosed epilepsy, the objective of this study was to examine the relationship between changes in severity of epilepsy and changes in HRQL over a 24-month period in children with and without cognitive problems.Methods: Data were obtained from the Health Related Quality of Life in Children with Epilepsy Study (HERQULES), a prospective multisite study of children aged 4-12 years with newly-diagnosed epilepsy followed for 24 months. Child, parent, and family factors were examined at baseline (post-diagnosis) and at 6, 12, and 24 months. Severity of epilepsy was measured using the Global Assessment of Severity of Epilepsy (GASE) as reported by pediatric neurologists. Neurologists also reported on child cognitive problems, coded as present or absent. Parents reported on HRQL using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). Multilevel, multiple-group latent growth curve modeling was used to examine the relationship between severity of epilepsy and HRQL for children with and without cognitive problems.Results: N=374 children were analyzed, of which 75 had cognitive problems. Children had a mean age of 7.5 (2.4) years and 52% were male. Children with cognitive problems differed significantly from those without cognitive problems on QOLCE scores at each time-point and on GASE scores at 12 and 24 months. Controlling for a minimal set of confounding factors [child age, sex, seizure type (generalized or partial), and family income], changes in severity of epilepsy had a significant impact on changes in HRQL for both children with and without cognitive problems. However, the effect was larger for children without cognitive problems ( =0.57, p<0.001) compared to children with cognitive problems ( =0.41, p=0.023). The variance in QOLCE scores explained by the GASE was also larger for children without cognitive problems (f2=0.38 vs. f2=0.16).Conclusions: For children with newly-diagnosed epilepsy, changes in severity of epilepsy are associated with changes in HRQL during the first 24 month post-diagnosis worsening of severity is associated with subsequent worsening of HRQL. Importantly, the magnitude of this effect is larger for children without cognitive problems. Given potential heterogeneity of effects, future research should strive to conduct subgroup analyses to clarify group-specific effects. Results may be useful for health professionals in understanding how changes in severity of epilepsy impact changes in HRQL in children with epilepsy and inform individualized care strategies for children with comorbid cognitive problems.