Abstracts

Rationale: In a cohort of children with epilepsy (CWE) followed for 9-years after diagnosis, we previously found that psychiatric comorbidity had a stronger negative association with HRQOL than did seizure remission status, defined as ?5-years seizure-free. Further, parent proxies rated the CWEs HRQOL as worse than they did for matched sibling controls. We now seek to determine: 1) if there is a gradient with worse HRQOL associated with more recent seizures, 2) if in CWE ?5 years seizure-free, whether a larger number of seizure days during the first few years after initial diagnosis (remote history) is associated with worse HRQOL, and 3) if parents and children report these associations between seizure occurrence and HRQOL differently.Methods: In a prospective, community-based study of newly diagnosed childhood epilepsy, HRQOL of 277 CWE was assessed 9 years after diagnosis, using the Child Health Questionnaire (CHQ), a generic HRQOL measure with child self-report (11 scales) and parent-proxy versions (12 scales). We examined the relationship between seizure recency and HRQOL at 9 years by comparing child and parent-proxy reported HRQOL of children seizure-free: (a) ?5 years, (b) 1-5 years or (c) <1 year, using age- and gender-adjusted analysis of covariance with pair-wise comparisons between groups. In the subset of 177 children seizure-free ?5 years, we analyzed the relationship of remote seizure history with HRQOL by comparing children with: (a) 0, (b) 1-10 or (c)?11 seizure-days (day with ?1 seizure) in the first 4 years after diagnosis.Results: Mean age of epilepsy onset was 4.4 (SD=2.6) years; 47% were female. At 9 years, mean child age was 13.0 (SD=2.6) years and 63.9%, 18.4%, and 17.7% were seizure-free ?5, 1-5 and <1 year(s), respectively. There were no significant differences between the ?5 years and 1-5 years seizure-free groups on any scale except parental emotional impact, but those seizure-free <1 year had lower (worse) mean HRQOL scores on 7 of 11 child-reported and 10 of 12 parent-proxy reported HRQOL scales compared to the other two groups. Of 177 children ?5 years seizure-free, 24.9%, 45.8% and 29.4% had experienced 0, 1-10 and ?11 seizure days, respectively, in the first 4 years after diagnosis. CWE with a remote history of ?11 seizure days had worse parent-reported HRQOL on 5 of 12 scales, including the 2 parent impact scales, compared to those with a remote history of 0 or 1-10 seizure days. No associations were found between child-reported HRQOL and remote seizure history.Conclusions: At 9-year follow-up of a cohort of CWE, HRQOL is worse for those having seizures in the prior year compared to those who were seizure-free for ?1 year. These associations are more pronounced for parent-proxy reported versus child-reported HRQOL. Although seizure remission is associated with better HRQOL, a larger prior cumulative seizure burden in the first four years after diagnosis is associated with worse parent-proxy reported HRQOL of CWE, suggesting that prior seizure burden has a persistent influence on current HRQOL even amongst CWE who are in a prolonged period of remission.