Memory and Health-Related Quality of Life in Severe Pediatric Epilepsy

Alberta Health Services and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
PEDIATRICS (Impact Factor: 5.3). 01/2013; 131(2). DOI: 10.1542/peds.2012-1428
Source: PubMed

ABSTRACT OBJECTIVES:The purpose of this paper was to investigate the contributions of sociodemographic, neurologic, and neuropsychological variables to health-related quality of life (HRQoL) in children with epilepsy and high seizure burden. Focus was placed on the relationship between memory and HRQoL, which has not been previously investigated.METHODS:Ninety children with epilepsy receiving clinical care at a tertiary-level children's hospital were retrospectively identified. Primary assessment measures were verbal memory (California Verbal Learning Test-Children's Version) and HRQoL. Other neuropsychological variables included intellectual function, executive function, emotional and behavioral function, and adaptive function. Sociodemographic and neurologic variables were extracted from chart review.RESULTS:No significant correlations were found between HRQoL and sociodemographic or neurologic variables. Moderate correlations were found between neuropsychological variables and HRQoL. Emotional function (Child Behavior Checklist) and verbal memory (California Verbal Learning Test-Children's Version) emerged as significant predictor variables of HRQoL. Low verbal memory was associated with a twofold risk of low HRQoL, emotional and behavioral difficulty with a 10-fold risk, and the combination of emotional and behavioral difficulty and low verbal memory with a 17-fold risk.CONCLUSIONS:Verbal memory and emotional and behavioral difficulty are associated with increased risk of low HRQoL, even when other important variables are considered in children with high seizure burden. The results reinforce the importance of neuropsychological assessment in clinical care in pediatric epilepsy and suggest important areas of focus for psychological intervention.

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    ABSTRACT: There is a lack of population-based data on specific cognitive profiles in childhood epilepsy. This study sought to determine the frequency of impairments in global cognition and aspects of working memory and processing speed in a population-based sample of children with "active" epilepsy (on antiepileptic Drugs (AEDs), and/or had a seizure in the last year). Factors significantly associated with global and specific difficulties in cognition were also identified. A total of 85 (74% of eligible population) school-aged children (5-15 years) with "active" epilepsy underwent comprehensive psychological assessment including assessment of global cognition, working memory, and processing speed. Scores on cognitive subtests were compared via paired-samples t tests. The factors associated with cognitive difficulties were analyzed via linear regression. A total of 24% of children were functioning below IQ 50, and 40% had IQ scores below 70. Scores on the Processing Speed Index were significantly lower than scores on the Verbal or Performance indexes on Wechsler instruments. The Coding subtest was a significant weakness compared with the other Wechsler subtests. A total of 58% of children displayed "memory underachievement" (memory score 1 SD below assessed IQ) on at least one of the four administered working memory subtests. Factors significantly associated with globally impaired cognition included being on polytherapy (β = -13.0; 95% CI [-19.3, -6.6], p = .000) and having attention-deficit/hyperactivity disorder (ADHD; β = -11.1, 95% CI [-3.0, -19.3], p = .008). Being on polytherapy was also associated with lower scores on the working memory and processing speed composite scores. Having developmental coordination disorder (DCD) was associated with a lower score on the processing speed composite. There is a high rate of global and specific cognitive difficulties in childhood epilepsy. Difficulties are most pronounced in aspects of working memory and processing speed. Predictors of cognitive impairment in childhood epilepsy include epilepsy-related and behavioral factors, which may differ depending on the domain of cognition assessed.
    Journal of Clinical and Experimental Neuropsychology 04/2015; 37(4):1-10. DOI:10.1080/13803395.2015.1024103 · 2.16 Impact Factor
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    ABSTRACT: INTRODUCTION. Epilepsy is a chronic neurological syndrome that is accompanied by abnormal, synchronic and exaggerated discharges in the cerebral cortex. Epilepsy is inversely related to health-related quality of life (HRQL), although little has been published on this relationship in children in Latin America. AIM. To examine the relation between epilepsy and HRQL in a group of schoolchildren aged 8-12 years who were treated in a paediatric hospital in Sonora, Mexico. PATIENTS AND METHODS. A cross-sectional study was conducted to compare the HRQL of children diagnosed with epilepsy with respect to the HRQL of two control groups. The validated questionnaire Paediatric Quality of Life Inventory was used to evaluate HRQL. Differences were examined by means of an ANOVA test and the association between epilepsy and HRQL was modelled by means of multiple logistic regression. RESULTS. The children with epilepsy displayed the lowest HRQL score (62.4 ± 14.8) of the subjects studied and had 5.2 times as much risk of their HRQL deteriorating (95% confidence interval = 2.43-11.06) compared to healthy children. Deterioration was greater on the cognitive (54.6 ± 15.0) and emotional scales (55.9 ± 23.6). Polypharmacy, i.e. the concomitant ingestion of three or more drugs (p < 0.001), and the chronological progression of suffering (p < 0.001) are factors that significantly deteriorate the HRQL of children with epilepsy. CONCLUSIONS. Epilepsy gives rise to an overall deterioration in the HRQL of children, specifically in the cognitive and emotional spheres, which is related with the chronological progression of the disease and polypharmacy.
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    ABSTRACT: Purpose Research suggests an increased risk for cognitive impairment in childhood epilepsy with memory being one area of cognition most likely to be affected. Understanding the prevalence and predictors of memory difficulties may help improve awareness of the difficulties and allow efficacious supports to be put in place. Method A systematic review was carried out using the search terms ‘memory’, ‘children’ and ‘epilepsy’ in the database PUBMED. Eighty-eight studies met inclusion criteria. The review focuses on comparisons of memory scores of children with epilepsy and controls, and comparison of memory scores of children with epilepsy to normative scores. Predictors of memory impairment and the effect of surgery on memory functioning are also reviewed. Results The majority (78%) of studies reviewed revealed that children with epilepsy scored lower than controls and normative scores on measures of memory. Post-surgery, memory scores were reported to improve in 50% of studies. Predictors of memory impairment included a greater number of AEDs used, younger age of onset, increased seizure frequency and longer duration of epilepsy. Conclusion Children with epilepsy have a high frequency of memory impairments. However, the exact prevalence of difficulties is not clear due to the lack of population-based data. Most studies have not controlled for IQ and thus it is unclear if difficulties are always related to global cognitive difficulties. There is need for future population-based studies and studies focussing on the neurobiology of memory problems in children with epilepsy.
    Seizure 10/2014; 25. DOI:10.1016/j.seizure.2014.10.002 · 2.06 Impact Factor