Abstracts

Rationale: The purpose of this research was to improve understanding of the process of emotional well-being (EWB) in children with newly-diagnosed epilepsy as a step towards optimizing their health-related quality of life. The primary objectives were to examine trajectories and predictors of emotional well-being in children with newly diagnosed epilepsy. Methods: A sample of 374 children ages four to twelve with newly diagnosed epilepsy was analyzed from the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES), a multi-centre prospective cohort study. Emotional well-being was measured using the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire. Trajectories of EWB were investigated using growth-modeling techniques, and epilepsy-related and family-related factors were compared across groups using analysis of variance (ANOVA) and chi-square tests. Multinomial logistic regression identified predictors of trajectory class membership. Results: A total of 344 children followed across four times (baseline, 6-months, 12-months, and 24-months) were represented by three distinct quadratic trajectories: low increasing (12%), moderate decreasing (26%), and moderate increasing (62%). In both the low increasing group and moderate decreasing group, initial EWB scores were determined by epilepsy-related factors: frequency of seizures, presence of behavior problems and presence of cognitive problems. In contrast, initial EWB scores in the moderate increasing group was determined by both epilepsy-related and family-related factors: current AED-use, presence of behaviour problems, presence of cognitive problems, family demands, and family functioning. Each trajectory group had a unique set of factors affecting growth across time. Comparisons among the trajectories using the moderate increasing group for reference indicated that both the low increasing group and moderate decreasing group had worse family functioning, a greater number of seizures, and were more likely to have behaviour problems. Parental depressive symptoms were greater in both groups, but this effect was diminished with the inclusion of family factors, suggesting the presence of a mediation effect. Conclusions: Poor EWB and worse mental health outcomes are common in children with new-onset epilepsy, in both children with and without controlled seizures. These children are not a homogeneous group, but consistent of groups with unique trajectories and patterns of factors determining trajectory growth. Family functioning was the strongest family factor identified while presence of behaviour problems had the largest impact on initial EWB. Epilepsy and family factors had unique effects on EWB trajectories, suggesting that treatment of clinical factors only may not adequately improve emotional well-being. Health care professionals should consider routinely assessing family factors in addition to clinical factors during pediatric epilepsy appointments.