Abstracts

Rationale: It is well known that both biological and psychosocial variables influence the behaviors of epileptic children. We have been conducting an observational study to better understand the extent, types, possible determinants, and impact on quality of life of behavioral problems noted by parents of epileptic Hispanic children from predominantly Spanish-speaking households. Methods: We recruited subjects between 2 to 18 years of age clinically diagnosed with epilepsy receiving ongoing treatment at Los Angeles County + University of Southern California Medical Center. Sociodemographic and epilepsy information were collected, and caregivers completed the Short Acculturation Scale for Hispanics (SASH), developmentally and language appropriate versions of the Child Behavior Checklist (CBCL), Adaptive Behavior Assessment System II (ABAS), Pediatric Quality of Life Inventory (PedsQL), and Impact of Childhood Neurologic Disease Scale (ICNDS). Minitab Release 14.20 software was utilized for statistical analyses. Results: We have enrolled 130 subjects with an age of 10.9 ± 4.7 years (mean ± standard deviation), with 55% being males and 95% identifying themselves as Hispanic or Latino. 73% stated that they have an annual household income of less than $20,000, with 69% overall receiving some form of government aid. Etiologically, 14% of subjects have genetic forms of epilepsy, 59% structural/metabolic causes, and 27% unknown. In terms of seizure control, 52% were experiencing less than one seizure over the past three months, while the remainder had variable but higher frequency of seizures. Patients with low ABAS scores had significantly worse epilepsy control (P = 0.001) and more structural/metabolic etiologies, with poorer quality of life scores (P values < 0.001 for both PedsQL and ICNDS). We found that 32% versus 30% score in the clinically significant range for internalizing versus externalizing behavioral problems on CBCL, respectively, with 17% having significant behavioral dysfunction in both domains. We found no correlation between clinically-significant CBCL T-scores and age, gender, or seizure characteristics (etiology, frequency, and number of antiepileptic medications). However, CBCL internalizing but not externalizing T-scores negatively correlated with ABAS scores (P value <0.01) and with two health-related quality of life scales (PedsQL and ICNDS, both P values < 0.001). While we found a statistically significant negative correlation between acculturation scores and CBCL internalizing T-scores, the relatively low acculturation score of 1.8 ± 0.97 (mean ± standard deviation) of our culturally-homogenous cohort prevents clinically meaningful interpretation. Moreover, acculturation scores alone were not associated with quality of life scores. Conclusions: Even amongst poor Hispanic children from predominantly Spanish-speaking households, internalizing behavioral problems appear to be predictive of health-related quality of life, independent of seizure control, number of anticonvulsant drugs, and underlying epilepsy etiology.