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Vacca M, Fernandes M, Veronese L, Ballesio A, Cerminara C, Galasso C, Mazzone L, Lombardo C, Mercuri NB, Liguori C. Clinical, Sociodemographic, and Psychological Factors Associated with Transition Readiness in Patients with Epilepsy. Brain Sci 2023; 14:21. [PMID: 38248236 PMCID: PMC10813513 DOI: 10.3390/brainsci14010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The transition to adult care for patients with epilepsy is a complicated clinical issue associated with adverse outcomes, including non-adherence to treatment, dropout of medical care, and worse prognosis. Moreover, youngsters with epilepsy are notably prone to emotional, psychological, and social difficulties during the transition to adulthood. Transition needs depend on the type of epilepsy and the epileptic syndrome, as well as on the presence of co-morbidities. Having a structured transition program in place is essential to reduce poor health consequences. A key strategy to optimize outcomes involves the use of transition readiness and associated factors assessment to implement the recognition of vulnerability and protective aspects, knowledge, and skills of these patients and their parents. Therefore, this study aims to provide a comprehensive framework of clinical and psychosocial aspects associated with the transition from pediatric to adult medical care of patients with epilepsy. METHODS Measures examining different aspects of transition readiness and associated clinical, socio-demographic, psychological, and emotional factors were administered to 13 patients with epilepsy (Mage = 22.92, SD = 6.56) with (n = 6) or without (n = 7) rare diseases, and a respective parent (Mage = 56.63, SD = 7.36). RESULTS patients showed fewer problems in tracking health issues, appointment keeping, and pharmacological adherence as well as low mood symptoms and moderate resiliency. Moreover, they referred to a low quality of sleep. Notably, parents of patients with rare diseases reported a lower quality of sleep as compared to the other group of parents. CONCLUSIONS Increasing awareness around transition readiness is essential to promote self-management skills of patients with epilepsy and their parents. Anticipating the period of transition could be beneficial, especially to prevent problematic sleep patterns and promote independence in health care management. Parents of patients with epilepsy and rare diseases should be monitored for their mental status which can affect patients' well-being.
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Affiliation(s)
- Mariacarolina Vacca
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (A.B.); (C.L.)
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
| | - Lorenzo Veronese
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
| | - Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (A.B.); (C.L.)
| | - Caterina Cerminara
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Hospital, Viale Oxford 81, 00133 Rome, Italy;
| | - Cinzia Galasso
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Hospital, Viale Oxford 81, 00133 Rome, Italy;
| | - Luigi Mazzone
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Hospital, Viale Oxford 81, 00133 Rome, Italy;
| | - Caterina Lombardo
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (A.B.); (C.L.)
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
- Epilepsy Center, Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
- Epilepsy Center, Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
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Brothers SL, Clifford LM, Guilfoyle SM, Wagner JL, Junger K, Huszti H, Modi AC. Key predictors of epilepsy-specific health-related quality of life (HRQOL) in youth with epilepsy. Epilepsy Behav 2023; 149:109508. [PMID: 37931390 DOI: 10.1016/j.yebeh.2023.109508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Epilepsy-specific health-related quality of life (HRQOL) is an important outcome in youth with epilepsy (YWE). The PedsQL™ Epilepsy Module is the only caregiver-proxy and youth self-report epilepsy-specific HRQOL measure that can be used with youth 2-25 years. Multiple factors affect HRQOL, including epilepsy-specific characteristics, comorbid mental and behavioral health concerns, as well as sociodemographic factors. However, we have not yet examined the cumulative impact of these factors on epilepsy-specific HRQOL in YWE using the PedsQL™ Epilepsy module. METHOD Youth with epilepsy (n = 281) and their caregivers completed questionnaires focused on sociodemographic factors (e.g., youth biological sex and age), mood/anxiety and behavior symptoms (i.e., Behavioral Assessment Scale for Children - Second Edition; BASC-2, Parent Rating Scale), epilepsy characteristics [e.g., seizure frequency, number of anti-seizure medications (ASMs), ASM side effects, and years since diagnosis], and the PedsQL™ Epilepsy module (subscales: Impact, Cognitive Functioning, Executive Functioning, Sleep, and Mood/Behavior). RESULTS Hierarchical linear regressions were conducted to examine caregiver-proxy and youth self-reported factors that affect epilepsy-specific HRQOL. Results indicate the strongest key shared predictors of HRQOL in YWE, for both youth and caregiver informants, were mental and behavioral health symptoms. For instance, caregiver-proxy report of YWE HRQOL indicated BASC-2 Externalizing (p < 0.05), Behavioral Symptoms (p < 0.01), and Adaptive Skills (p < 0.001) explained 58 % of the variance in youth Cognitive Functioning HRQOL, while youth self-report of HRQOL indicated that BASC-2 Externalizing (p < 0.01), Behavioral Symptoms (p < 0.05), and Adaptive Skills (p < 0.001) contributed only 36 % of the variance in Cognitive Functioning HRQOL above and beyond the variance explained by sociodemographic and epilepsy-specific characteristics. Similar results were noted for Executive Functioning HRQOL domain, wherein caregiver-proxy report of YWE HRQOL indicated BASC-2 Internalizing (p < 0.01), Behavioral Symptoms (p < 0.001) and Adaptive Skills (p < 0.001) explained 65 % of variance in Executive Functioning, whereas youth self-report of Executive Functioning HRQOL indicated that caregiver-proxy BASC-2 Internalizing (p < 0.001) and Behavioral Symptoms (p < 0.01) explained 34 % of the variance in Executive Functioning HRQOL, above and beyond the variance explained by sociodemographic and epilepsy-specific characteristics. Unique mental and behavioral health predictors of YWE HRQOL were also found for both caregiver-proxy and youth self-report. CONCLUSIONS Given the integral role of mental and behavioral health symptoms in epilepsy-specific HRQOL, it is critical to address mental and behavioral health symptoms preventatively and proactively to provide YWE with the most optimal health plan, including good seizure control, minimal ASM side effects, and the best possible HRQOL.
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Affiliation(s)
- Shannon L Brothers
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, MLC 3015, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine, CARE/Crawley Building, 3230 Eden Avenue, Suite E-870, Cincinnati, OH 45267, United States.
| | - Lisa M Clifford
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, MLC 3015, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine, CARE/Crawley Building, 3230 Eden Avenue, Suite E-870, Cincinnati, OH 45267, United States
| | - Shanna M Guilfoyle
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, MLC 3015, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine, CARE/Crawley Building, 3230 Eden Avenue, Suite E-870, Cincinnati, OH 45267, United States
| | - Janelle L Wagner
- The Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States
| | - Katherine Junger
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, MLC 3015, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine, CARE/Crawley Building, 3230 Eden Avenue, Suite E-870, Cincinnati, OH 45267, United States
| | - Heather Huszti
- Children's Hospital of Orange County, 1201 W La Veta Ave, Orange County, CA 92868, United States
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, MLC 3015, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine, CARE/Crawley Building, 3230 Eden Avenue, Suite E-870, Cincinnati, OH 45267, United States
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Rojulpote KV, Smith ML, Puka K, Speechley KN, Ferro MA, Connolly MB, Major P, Gallagher A, Almubarak S, Hasal S, Ramachandrannair R, Andrade A, Xu Q, Leung E, Snead OC, Widjaja E. Pre-Operative Predictors of Health-Related Quality of Life Two Years After Pediatric Epilepsy Surgery: A Prospective Cohort Study. Seizure 2023; 111:196-202. [PMID: 37683452 DOI: 10.1016/j.seizure.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Seizure freedom is an important predictor of health-related quality of life (HRQOL) after pediatric epilepsy surgery. This study aimed to identify the pre-operative predictors of HRQOL 2 years after epilepsy surgery in children with drug-resistant epilepsy. METHODS This multicenter prospective cohort study assessed pre-operative predictors including child (demographics and clinical variables), caregiver (including caregiver depressive and anxiety symptoms) and family characteristics. HRQOL was assessed using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55 pre-operatively and 2-years after surgery. Univariable linear regression analyses were done to identify significant preoperative predictors of HRQOL 2-years after surgery, followed by multivariable regression. RESULTS Ninety-five children underwent surgery, mean age was 11.4 (SD=4.2) years, and 59 (62%) were male. Mean QOLCE scores were 57.4 (95%CI: 53.8, 61.0) pre-operatively and 65.6 (95%CI: 62.0, 69.1) after surgery. Univariable regression showed fewer anti-seizure medications (ß=-6.1 [95%CI: -11.2, -1.0], p = 0.019), older age at seizure onset (ß=1.6 [95%CI: 0.8, 2.4], p<0.001), higher pre-operative HRQOL (ß=0.7 [95%CI: 0.5, 0.8], p<0.001), higher family resources (ß=0.6 [95%CI: 0.3, 0.9], p<0.001), better family relationships (ß=1.7 [95%CI: 0.3, 3.1], p = 0.017) and lower family demands (ß=-0.9 [95%CI: -1.5, -0.4], p<0.001) were associated with higher HRQOL after surgery. Caregiver characteristics did not predict HRQOL after surgery (p>0.05). Multivariable regression showed older age at seizure onset (ß=4.6 [95%CI: 1.6, 7.6], p = 0.003) and higher pre-operative HRQOL (ß=10.2 [95%CI: 6.8, 13.6], p<0.001) were associated with higher HRQOL after surgery. CONCLUSION This study underscores the importance of optimizing pre-operative HRQOL to maximize HRQOL outcome after pediatric epilepsy surgery.
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Affiliation(s)
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Philippe Major
- Division of Neurology, Department of Neurosciences, CHU Ste-Justine Hospital, University of Montreal, QC, Canada
| | - Anne Gallagher
- Centre de Recherche, CHU Ste-Justine Hospital, University of Montreal, QC, Canada
| | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada; Qatif Central Hospital, Qatif, Saudi Arabia
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Andrea Andrade
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Edward Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, Lurie Children's Hospital, Chicago, IL, USA.
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