Abstracts

Rationale: Previous studies have reported that children with epilepsy are at risk for cognitive impairments. In addition to severity of epilepsy, family factors have also recently been cited as influencing cognitive functioning in children. The two objectives were to assess the: (1) relationship between severity of epilepsy and cognitive functioning in children with new-onset epilepsy at baseline, 6, 12 and 24-months; and (2) moderating and mediating effects of family factors on the relationship between severity of epilepsy and cognitive functioning at baseline, 6, 12 and 24-months. Methods: Data came from the Health-related Quality of Life of Children with Epilepsy Study (HERQULES), a multi-centre prospective cohort study of children aged 4-12 years with new onset epilepsy that were followed for 2 years. From eligible families, 374 parents completed the mailed questionnaire at baseline (response rate 82%) and 282 at 24-months. The Global Assessment of Severity of Epilepsy (GASE) scale measured severity of epilepsy and the cognitive functioning subscale on the Quality of Life in Childhood Epilepsy (QOLCE) scale assessed cognitive functioning in children. Three family factors were assessed. The Family Inventory of Life Events and Changes (FILE) measured family demands; Family Adaptability, Partnership, Growth, Affection & Resolve (APGAR) measured family functioning; and the Family Inventory of Resources for Management (FIRM) measured family resources. Multiple linear regression models were used to identify the relationship between severity of epilepsy and cognitive functioning, while generalized estimating equations approach was adapted to statistically assess mediating and moderating effects of family factors on the relationship between severity of epilepsy and cognitive functioning. Results: The mean age of the sample was 7.4 (± 2.4) years; approximately half (52%) of the children in the sample were males; and 61% had partial seizures. The majority of children (59%) had "a little severe" or "somewhat severe" epilepsy. There was a statistically significant negative association between severity of epilepsy and cognitive functioning, controlling for seizure type and antiepileptic drugs at the 6, 12 and 24-month follow-up (p=0.0006 to <0.0001). Family demands (p=0.02) and family functioning (p=0.03) were both found to significantly mediate the relationship between severity of epilepsy and cognitive functioning at the 12-month follow-up. Family resources was not found to be a moderator in this relationship at any time-point (p=0.51 to 0.81). Conclusions: Children with more severe epilepsy have worse cognitive functioning. The relationship between severity of epilepsy and cognitive functioning does not depend on the level of family resources. The association between severity of epilepsy and cognitive functioning is partially mediated by family demands and family functioning at one-year post diagnosis. These findings suggest opportunities for intervention in reducing the impact of epilepsy on cognitive functioning.