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Cook G, Bray L, Carter B, Gringras P, Morris C, Pal DK, Saron H, Tudur Smith C, Wiggs L. A cross-sectional survey of healthcare professionals supporting children and young people with epilepsy and their parents/carers: which topics are raised in clinical consultations and can healthcare professionals provide the support needed? Epilepsy Behav 2023; 149:109543. [PMID: 38006842 DOI: 10.1016/j.yebeh.2023.109543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND PURPOSE Children and young people (CYP) with epilepsy see healthcare professionals (HCPs) for management of their seizures but may require information, advice and support with a range of broader topics. The purpose of the survey was to identify from HCPs, which topics CYP with epilepsy and their parents/carers ask about other than seizure management, and how adequately HCPs feel able to support them with these topics. METHOD A cross-sectional online survey was used to collect data. Adverts which included a link to the survey were shared via social media channels, professional networks and United Kingdom (UK)-based epilepsy networks. Eighty-eight HCPs in the UK (who worked with CYP with epilepsy and their parents/carers) completed the survey. Quantitative data are presented descriptively. Qualitative data (free-text responses) were reflexively thematically analysed. RESULTS CYP with epilepsy and their parents/carers were reported to ask HCPs for information, advice and support about a range of topics, most commonly, cognition and mental health. CYP were reported as also frequently asking about aspects of their social life while parents/carers commonly asked about sleep. HCPs varied in how able they felt to adequately support families about these topics, as well as in their views about which resources could be most useful. Having insufficient time and a lack of suitable services and resources to refer to, or draw upon, were key barriers to HCPs being able to support CYP and their families. DISCUSSION Findings highlight the broad array of topics CYP with epilepsy and their families are reported as seeking support for. HCPs identified gaps in services and their abilities to meet those needs. There appeared to be a mismatch between the support that families were seeking and the ability of HCPs to meet these needs. Findings have implications for how HCPs could best be supported to deal with topics raised by CYP and families in clinic, highlighting the potential usefulness of informational resources on key topics for HCPs, parents/carers and CYP.
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Affiliation(s)
- Georgia Cook
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK.
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Paul Gringras
- Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK; Kings College London, Strand, London, WC2R 2LS, UK
| | - Christopher Morris
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Deb K Pal
- Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK; MRC Centre for Neurodevelopmental Disorders, Neurodevelopmental Disorders, New Hunt's House, Guy's Campus, King's College London, SE1 1UL, UK; Variety Club Children's Department, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Holly Saron
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Catrin Tudur Smith
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Luci Wiggs
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK
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Simeon R, Berardi A, Valente D, Volpi T, Vagni S, Galeoto G. Occupational Therapy Intervention in the Child with Leukodystrophy: Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1257. [PMID: 37508754 PMCID: PMC10377904 DOI: 10.3390/children10071257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND There are many different types of Leukodystrophies. Specifically, children with hypomyelination and congenital cataract syndrome (HCC) in addition to motor retardation development, hypotonia and progressive spastic paraplegia, associated with cerebellar ataxia and peripheral neuropathy, have early bilateral cataracts and intellectual disability as pathognomonic symptoms. HCC rehabilitation treatment is not well defined, but a significant amount of evidence in the literature has demonstrated the effectiveness of occupational therapy (OT) treatment in children with similar symptomatology. For this reason, the aim of this study was to describe the improvement in the autonomies and social participation of a child with HCC following OT treatment. METHODS A.E. was a 9-year-old child with HCC with severe intellectual disability. OT intervention lasted 3 months biweekly and each session lasted 45 min. Each session was divided into two parts: The first part aimed to increase the child's active involvement through activities; the second part involved training in Activities of Daily living (ADL). The outcome measures were: ABILHAND-Kids; Pediatric Evaluation of Disability Inventory; Comprehensive OT Evaluation Scale; ADL and Instrumental Activities of Daily Living. RESULTS A.E.'s outcome measure reported an improvement from an autonomy standpoint and in the child's general activity participation; there was also an increase in A.E.'s interpersonal skills. CONCLUSION OT treatment improved A.E.'s autonomy.
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Affiliation(s)
- Rachele Simeon
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy
| | | | - Samuele Vagni
- School of Occupational Therapy, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy
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Sadanandan SA, Shreedevi AU, Padmanabha H. Parental KAP and its Relation with the Quality of Life in Children with Epilepsy. Ann Indian Acad Neurol 2023; 26:419-423. [PMID: 37970311 PMCID: PMC10645211 DOI: 10.4103/aian.aian_199_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/20/2023] [Accepted: 06/02/2023] [Indexed: 11/17/2023] Open
Abstract
Background Epilepsy is a chronic disorder with recurrent unprovoked seizures which can affect children at any age. A child's quality of life (QOL) is significantly impacted by an epilepsy diagnosis throughout their formative years. Adjustment and QOL for the child and family are highly correlated with parental knowledge, attitudes, and practices (KAP) regarding epilepsy. Objectives Determining the association between parental KAP and the QOL of children with epilepsy (CWE) and to study the association between them. Materials and Methods Using convenience sampling procedure, 30 CWE between the ages of 6 and 14-of either sex-and their 30 parents made up the sample. The knowledge, attitude, and practice (KAP) tool, which was given to parents, and the Quality of Life in Childhood Epilepsy Questionnaire-55 (QOLCE-55), which was given to CWE, were used to gather the data. Frequency distribution, percentage, and correlation coefficient tests were used to assess the measures. Results There were statistically significant relationships between the QOL and KAP domains and parental education, domicile, and socioeconomic position. The cognitive, emotional, and social domains of QOL were adversely connected with the knowledge domain in KAP, but the physical domain was positively correlated. Parents' behavior and physical QOL were found to be negatively correlated. Conclusion Although educated parents had sufficient information and a positive outlook, there was a discrepancy between recommended and actual practice, and KAP has an impact on the QOL of CWE. Parental education initiatives may significantly improve understanding and promote healthy behaviors.
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Affiliation(s)
- Sanithamol A. Sadanandan
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Athyadi U. Shreedevi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hansashree Padmanabha
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Alnaamani A, Ahmad F, Al-Saadoon M, Rizvi SGA, Al-Futaisi A. Assessment of quality of life in children with epilepsy in Oman. J Patient Rep Outcomes 2023; 7:9. [PMID: 36729202 PMCID: PMC9895491 DOI: 10.1186/s41687-023-00555-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The study aims to describe the quality of life (QoL) in Omani children with epilepsy at Sultan Qaboos University Hospital, Oman. METHODS One hundred and one Omani children, with an age range from 5 to 18 years, diagnosed with epilepsy were enrolled in the study over 3 months. Descriptive epidemiology was used to characterize QoL in these children. QoL was measured using the PedsQL (4.0) questionnaire, a 23-item child and parent report questionnaire. Analysis of variance (ANOVA) was used to compare mean QoL scores, and agreement between the QoL reports of children and parents was evaluated using Spearman's rho; while, Multivariate analysis of variance (MANOVA) was performed to determine differences in subscale ratings. RESULTS Factors affecting QoL included family status, income level, social security coverage, type of treatment, seizure frequency, age of onset, and seizure-free duration in years. Children between 5 and 7 years and females, in general, were most affected, as reflected by the overall QoL subscale. Consistency between the children's self-reports and parent proxy reports on the PedsQL™ was moderate to low. CONCLUSION Omani children with epilepsy have poor QoL, and their psychosocial function is severely affected. Therefore, QoL should be an important outcome measure in managing children with epilepsy rather than just seizure control.
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Affiliation(s)
- Asia Alnaamani
- grid.415703.40000 0004 0571 4213Child Health, Department of Woman and Child Health, Ministry of Health, 123 Alkhoud, Muscat, Oman
| | - Faraz Ahmad
- grid.412855.f0000 0004 0442 8821Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman ,grid.412846.d0000 0001 0726 9430Sultan Qaboos University, P.O. Box 38, 123 Al-Khoudh, Oman
| | - Muna Al-Saadoon
- grid.412846.d0000 0001 0726 9430Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, 123 Al-Khoudh, Muscat, Oman
| | - Syed Gauhar Alam Rizvi
- grid.412846.d0000 0001 0726 9430Sultan Qaboos University, P.O. Box 38, 123 Al-Khoudh, Oman ,grid.412846.d0000 0001 0726 9430Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Amna Al-Futaisi
- grid.412846.d0000 0001 0726 9430Sultan Qaboos University, P.O. Box 38, 123 Al-Khoudh, Oman ,grid.412846.d0000 0001 0726 9430Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, 123 Al-Khoudh, Muscat, Oman
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Nabavi Nouri M, Puka K, Palmar K, Speechley KN. Impact of number of anti-seizure medications on long-term health-related quality of life in children with epilepsy: A prospective cohort study. Seizure 2022; 99:120-126. [PMID: 35636159 DOI: 10.1016/j.seizure.2022.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/01/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Health-related quality of life (HRQL) is compromised in children with epilepsy. We aimed to determine whether children diagnosed with epilepsy between ages 4-12 years who are exposed to a higher number of anti-seizure medication (ASM) over the first 2 years, have poorer HRQL 10 years after diagnosis. METHODS Data were obtained from 195 children enrolled in the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES) in Canada. HRQL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) completed by parents at baseline through to 10 years after diagnosis. The total number of ASM were reported by physicians four times in the first two years after diagnosis. Multivariable block-wise linear regression was used to assess the impact of ASM (categorized as none, one, or more than one), as well as clinical and family factors on children's HRQL 10 years after diagnosis. RESULTS Children had a mean age of 7.9 ± 2.3 years at diagnosis and 92 (47%) were female. Mean QOLCE at baseline and 10 years was 72.04±14 and 78.7±16,respectively. Clinically meaningful improvement in HRQL from the 2 to 10-year follow-up was detected in 35% of children, reported similarly across all ASM treatment categories (p = .38). The number of ASM prescribed in the first two years was associated with HRQL at the 10-year follow-up, however this association was not significant when adjusting for clinical characteristics, family factors, and HRQL at the two-year follow-up (p = .75). Our data showed that HRQL at 2 years was the only variable associated with better HRQL scores at 10 years (p = <.001). CONCLUSION In children with new onset epilepsy, exposure to a higher number of ASM, when accounting for clinical and family factors as well as HRQL at 2 years, is not independently associated with lower long-term HRQL. Early HRQL was found to be a good indicator of long-term HRQL, despite the number of ASMs prescribed.
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Affiliation(s)
- Maryam Nabavi Nouri
- Department of Pediatrics, Schulich school of Dentistry and Medicine, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.
| | - Klajdi Puka
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada; Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Katie Palmar
- Department of Clinical Geriatrics, NVS, Karolinska Institute, Stockholm, Sweden
| | - Kathy N Speechley
- Department of Pediatrics, Schulich school of Dentistry and Medicine, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada; Epidemiology and Biostatistics, Western University, London, ON, Canada
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Morningstar M, Grannis C, Mattson WI, Nelson EE. Functional patterns of neural activation during vocal emotion recognition in youth with and without refractory epilepsy. Neuroimage Clin 2022; 34:102966. [PMID: 35182929 PMCID: PMC8859003 DOI: 10.1016/j.nicl.2022.102966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/12/2022] [Accepted: 02/11/2022] [Indexed: 01/10/2023]
Abstract
Epilepsy has been associated with deficits in the social cognitive ability to decode others' nonverbal cues to infer their emotional intent (emotion recognition). Studies have begun to identify potential neural correlates of these deficits, but have focused primarily on one type of nonverbal cue (facial expressions) to the detriment of other crucial social signals that inform the tenor of social interactions (e.g., tone of voice). Less is known about how individuals with epilepsy process these forms of social stimuli, with a particular gap in knowledge about representation of vocal cues in the developing brain. The current study compared vocal emotion recognition skills and functional patterns of neural activation to emotional voices in youth with and without refractory focal epilepsy. We made novel use of inter-subject pattern analysis to determine brain areas in which activation to emotional voices was predictive of epilepsy status. Results indicated that youth with epilepsy were comparatively less able to infer emotional intent in vocal expressions than their typically developing peers. Activation to vocal emotional expressions in regions of the mentalizing and/or default mode network (e.g., right temporo-parietal junction, right hippocampus, right medial prefrontal cortex, among others) differentiated youth with and without epilepsy. These results are consistent with emerging evidence that pediatric epilepsy is associated with altered function in neural networks subserving social cognitive abilities. Our results contribute to ongoing efforts to understand the neural markers of social cognitive deficits in pediatric epilepsy, in order to better tailor and funnel interventions to this group of youth at risk for poor social outcomes.
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Affiliation(s)
- M Morningstar
- Department of Psychology, Queen's University, Kingston, ON, Canada; Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.
| | - C Grannis
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - W I Mattson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - E E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
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Gao Y, Tang X, Wen Y, Qian D, Pan X, Zhang L. Effects of the hospital-community-family ternary linkage continuous nursing model on compliance, cognitive function, resilience, and quality of life for children with epilepsy: a retrospective study. Transl Pediatr 2022; 11:239-248. [PMID: 35282024 PMCID: PMC8905107 DOI: 10.21037/tp-22-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Epilepsy is a chronic disease that can reduce the quality of life in children because it can cause memory loss, learning difficulties, mental and behavioral abnormalities, and social disorders. The purpose of this study was to explore the effect of the hospital-community-family linkage continuous nursing model in the nursing of children with epilepsy. METHODS Data for 136 children with epilepsy who were hospitalized in the neurology clinic or neurology ward of Wuxi Children's Hospital from January 2018 to January 2021 were retrospectively analyzed. According to the nursing mode after discharge, the children were divided into 65 cases in the observation group (hospital-community-family linkage continuous nursing model) and 71 cases in the control group (routine nursing model). The compliance with nursing, cognitive function, resilience, and quality of life of the two groups were compared before and after intervention, and the influencing factors of children's quality of life were analyzed. RESULTS The follow-up visit 6 months after discharge found that the scores for compliance, resilience, and quality of life in the observation group were significantly higher than those in the control group (P<0.05). The correlation analysis between quality of life, each child's general data, and the nursing model found that the total score of quality of life was correlated with incidence frequency, family per capita income, and the nursing model. CONCLUSIONS The adoption of a hospital-community-family linkage continuous nursing model can improve the compliance, resilience, and quality of life of children with epilepsy.
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Affiliation(s)
- Yali Gao
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
| | - Xiaohong Tang
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
| | - Yiyi Wen
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
| | - Daijing Qian
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
| | - Xingnan Pan
- Department of Science and Education, Wuxi Children's Hospital, Wuxi, China
| | - Linhui Zhang
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
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Murugupillai R, Muniyandi R, Arambepola C, Wanigasinghe J. Validation of the Sri Lankan Health-Related Quality-of-Life Index for pre-schoolers (SLHQL-P) and school age (SLHQL-S) children with epilepsy. Epilepsy Behav 2022; 127:108499. [PMID: 35032902 DOI: 10.1016/j.yebeh.2021.108499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/26/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Health-related quality of life (HRQL) in children and adolescents remains an underappreciated problem in Asian region, due to lack of culturally sound HRQL measures. This paper describes the validation process of two age-specific, proxy-rated HRQL indexes namely Sri Lankan Health-Related Quality-of-Life Index for preschoolers (SLHQL-P) and school age children (SLHQL-S) with epilepsy. METHODS Primary caregivers of children and adolescents with epilepsy aged 1-18 years from three districts in Sri Lanka were invited to fill the SLHQL-P (for 1-5 years) and SLHQLS (for 6-18 years). It was re-administered to a subset of consenting primary caregivers after an interval of two weeks. Scientific soundness of SLHQL-P and SLHQL-S were established based on causal indicator model. RESULTS Total of 98 and 169 primary caregivers responded to SLHQL-P, SLHQL-S respectively. Final questionnaires of SLHQL-P and SLHQL-S consists of 26, 57 items respectively in three multi-item domains measuring the child's physical functioning (6, 9 items), psychological functioning (6, 31 items) and social functioning (14, 17 items) with higher scores reflecting better HRQL. Construct validity was established by several methods including strong relationship with seizure severity. Good test-retest reliability was also demonstrated for both SLHQL-P and SLHQL-S (r = 0.77, 0.938) CONCLUSIONS: Both SLHQL-P and SLHQL-S are feasible, reliable and valid instruments to measure HRQL in children and adolescents with epilepsy in clinical as well as research settings in Sri Lanka.
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Affiliation(s)
- Roshini Murugupillai
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University Sri Lanka, No:50, New Road, Batticaloa, Sri Lanka.
| | - Ravi Muniyandi
- Department of Social Sciences, Faculty of Arts and Culture, Eastern University Sri Lanka, Vantharumoolai, Batticaloa, Sri Lanka
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, PO Box 25, Kynsey Road, Colombo 08, Sri Lanka
| | - Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, PO Box 25, Kynsey Road, Colombo 08, Sri Lanka
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Cahill PT, Ferro MA, Campbell WN, Ronen GM. Self-esteem mediates mental health outcomes in young people with epilepsy. Epilepsia 2021; 62:2072-2081. [PMID: 34275131 DOI: 10.1111/epi.17006] [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: 03/26/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the extent to which self-esteem mediates the impacts of epilepsy-specific and environmental factors on mental health outcomes in young people with epilepsy. METHODS A prospective cohort of 480 young people with epilepsy and their families participated in five visits over 28 months. We collected data on clinical seizure burden, cognitive comorbidity, peer and parental support, self-esteem, and self-reported mental health symptoms. We used structural equation modeling to specify and test relationships among these constructs simultaneously. Direct, indirect, and total effects were estimated with confidence intervals constructed through bias-corrected bootstrapping. RESULTS Self-esteem mediated the effects of clinical seizure burden ( β = 0.23, 95% confidence interval [0.05, 0.42]) and peer support ( β = -0.15, 95% CI [-0.28, -0.03]) on mental health. There were no mediating effects of parental support ( β = -0.07, 95% CI [-0.14, 0.00]) or cognitive comorbidity ( β = -0.01, 95% CI [-0.02, 0.01]) on mental health. SIGNIFICANCE We found evidence that self-esteem mediates the impact that both clinical seizure burden and peer support have on mental health outcomes, indicating that assessment of and interventions targeting self-esteem may be appropriate for young people with epilepsy. Supporting self-esteem could mitigate negative influences on mental health, whether from resistant epilepsy or low peer support.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Gabriel M Ronen
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada.,Department of Paediatrics (Neurology), McMaster University, Hamilton, ON, Canada
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Harden J, Black R, Pickersgill M, Shetty J, McLellan A, Brand C, Small M, McDonnell J, Clarke L, Chin RF. Children's understanding of epilepsy: A qualitative study. Epilepsy Behav 2021; 120:107994. [PMID: 33964537 PMCID: PMC8259124 DOI: 10.1016/j.yebeh.2021.107994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022]
Abstract
PURPOSE To use a qualitative research approach to determine children's understandings of epilepsy and their epilepsy treatment. METHODS Children aged 7-16 years with physician-confirmed active epilepsy (i.e., having had an epileptic seizure in the past year and or currently taking antiepileptic drugs (AEDs), and not known to have an intellectual disability, were invited to participate. Children had semi-structured interviews separately on two occasions. Between the first and second interviews, an observation of a routine epilepsy clinic appointment of individual children was conducted, and was then discussed during the second interview. Participatory research tools were used in both child interviews to facilitate discussions. Interviews were audio recorded and transcribed, pseudonymized and entered into NVivo (version 12, QSR International). Data were analyzed using a thematic approach. RESULTS Twenty-three children of mean age 10.1 years (range 8-14), mean duration of epilepsy of 4.6 years (range 2-10) were enrolled. Twelve were 12 female; 7 had focal, 14 had generalized, and 2 had combined epilepsy; 20 were on monotherapy; and 16 had tried previous AEDs. All had an initial (first) interview; 20 were observed during a clinic appointment and had a second interview. Five broad themes emerged: understanding of epilepsy; understanding of seizures; understanding of medication; understanding of children's role in clinical appointments; influences on children's understanding. Children spoke about what epilepsy meant by describing the physical sensations of having a seizure or through the act of taking medication. Children described the role they had, or felt they should have, but reported challenges in being meaningfully involved in clinical appointments. While healthcare professionals were initial information nodes, epilepsy information from parents appeared to be more significant for children. CONCLUSIONS The perspectives of children with epilepsy are valuable for clinicians to understand; assumptions should not be made that children's views can be accessed via parents. Clinicians need to be constantly aware of children's views and ways of understanding and communicating about their epilepsy. To support this, the research - drawing on children's words, meanings, and stories - was used to inform an easily accessible, gender-neutral, animation about epilepsy that provides information about the condition, seizures, and medication (https://youtu.be/MO7xXL2ZXP8).
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Affiliation(s)
- Jeni Harden
- Usher Institute, The University of Edinburgh, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, UK.
| | - Rebecca Black
- Usher Institute, The University of Edinburgh, UK,Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | - Martyn Pickersgill
- Usher Institute, The University of Edinburgh, UK,Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | - Jay Shetty
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, UK,Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK,Child Life and Health, MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Ailsa McLellan
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, UK,Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK,Child Life and Health, MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Celia Brand
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, UK,Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Michelle Small
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, UK,Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | | | | | - Richard F. Chin
- Usher Institute, The University of Edinburgh, UK,Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, UK,Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK,Child Life and Health, MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
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11
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Validation of the Health-Related Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) for Brazilian Portuguese. Epilepsy Behav 2021; 120:107969. [PMID: 33964539 DOI: 10.1016/j.yebeh.2021.107969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present study aimed to validate the 55-item Health-Related Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) in Brazilian Portuguese and evaluate the relation of its results with clinical data and caregiver burden. METHODS The QOLCE-55 was submitted to translation, back-translation, and cultural adaptation in a pilot sample with 20 subjects. To ensure the psychometric properties of validation, the validation of the QOLCE-55 was carried out in a sample of 45 patients with epilepsy aged between 4 and 18 years and their parents or caregivers and compared with the results of other quality-of-life instruments, namely, the QVCE-50 and QOLIE-AD-48, as well as with the SDQ, abrief behavioral screeningquestionnaire. The WASI and SON-R 2½-7 [a] were used for evaluation of intelligence quotient (IQ) and the Burden Interview for the caregiver burden. RESULTS Internal consistency measured by Cronbach's alpha coefficient was moderate (0.692; p = 0.264), and the test-retest reliability analyzed by the intraclass correlation coefficient was satisfactory when compared with the results by different examiners on the same day (0.951; p = 0.001) and at different times (0.778; p = 0.001). This version of the QOLCE-55 presented a strong correlation with the QVCE-50 (0.904; p < 0.001) and SDQ (-0.428; p = 0.004) but a low correlation with the QOLIE-AD-48 (0.094; p = 0.729). This version also presented a correlation with IQ (R = 0.456, p = 0.003) and an inverse correlation with the Burden Interview (-0.390; p = 0.012). Low quality of life was associated with the presence of tonic-clonic seizures (p = 0.005), polytherapy (p = 0.003), and low socioeconomic conditions (p = 0.005). CONCLUSIONS The Brazilian Portuguese version of the QOLCE-55 was confirmed as a reliable and valid scale to assess quality of life in children and adolescents with epilepsy. Behavioral problems, caregiver burden, tonic-clonic seizures, polytherapy, and socioeconomic precariousness were associated with low quality-of-life values, while IQ was positively correlated with the quality of life in this population.
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12
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Quality of life (QOL) narratives of growing up with epilepsy from youth and family perspectives. Epilepsy Behav 2021; 114:107613. [PMID: 33309235 DOI: 10.1016/j.yebeh.2020.107613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Qualitative research studies deepen our understanding of growing up with epilepsy but are limited to the singular perspective of children or their parents at one point in childhood. A more complete view requires multiple perspectives and narrative accounts that represent development from early childhood to young adulthood. Thematic study of life narratives of 7 young people and at least one person within their families were interviewed separately (15 participants) for two interviews each (30 interviews). The objective was to obtain narratives of the life experiences, the attributions of those experiences, and crucial periods relating to quality of life (QOL) with no apriori assumptions that their lives were shaped by epilepsy. Themes were formed inductively from subthemes and codes were created based on the constant comparative method by two interviewers who iteratively co-coded the data. RESULTS Themes emerging from the data: "Story of My Health," "Growing by Doing," "To Adapt or Not to Adapt," "Supports and Challenges," "Parent World," and "Looking in and Out, Forward and Back", often included components of seizure and epilepsy experiences but also mirrored life challenges of growing up in general. The only exclusively epilepsy-specific theme: "To Adapt or Not to Adapt", was about the challenges and solutions for dealing with the uncertainty caused by seizures and potential isolation that results from others' reactions. CONCLUSIONS There were a range of experiences related to QOL described by participants growing up with epilepsy. The 'ingredients' of a good life (e.g., social and self-acceptance) were consistent with QOL research for general populations, although these were often expressed as more difficult to attain when growing up with epilepsy.
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13
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Boldyreva U, Streiner DL, Rosenbaum PL, Ronen GM. Quality of life in adolescents with epilepsy, cerebral palsy, and population norms. Dev Med Child Neurol 2020; 62:609-614. [PMID: 31898321 DOI: 10.1111/dmcn.14450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 12/18/2022]
Abstract
AIM To compare: (1) self- and proxy-reported quality of life (QoL) in adolescents with epilepsy, cerebral palsy (CP), both epilepsy and CP, and a representative general population sample; and (2) parental stress between parents of adolescents with epilepsy, CP, or both epilepsy and CP. METHOD This was a cross-sectional observational study with 496 adolescents with epilepsy, 699 with CP, 192 with both CP and epilepsy, and 15 396 from the general population, assessed with the KIDSCREEN-52 and Parenting Stress Index (PSI). RESULTS All KIDSCREEN-52 domains showed statistically significant differences across groups. The epilepsy population showed clinically better scores for 'school environment' than the general population (Cohen's d=0.62). Parents scored adolescents with CP lower than adolescents with epilepsy or general populations on 'physical health' (d=0.57, d=0.55) and 'social-support and peers' (d=0.82, d=0.91). Parents of adolescents with CP scored them lower than parents of the epilepsy group on 'autonomy' (d=0.62). Parents of adolescents with epilepsy scored them lower on 'mood and emotions' (d=0.52) and 'social acceptance' (d=0.66) than the general population. PSI scores were better for parents of adolescents with CP than for parents of adolescents with epilepsy (d=2.12, d=2.70, d=3.35, d=1.67). INTERPRETATION Adolescents with epilepsy or CP self-report equal or better QoL than the general adolescent population, which should comfort families and allow clinicians to address parental concerns. WHAT THIS PAPER ADDS Adolescents with epilepsy, with or without cerebral palsy (CP), self-reported better school environment than adolescents in the general population. Proxy quality of life (QoL) results showed clinically important differences across groups in 6 out of 10 domains of the KIDSCREEN-52. Proxy-reported results showed poorer QoL scores for adolescents with epilepsy or CP than the general population. Parental stress level was lower in parents of children with CP or both CP and epilepsy, than in those with only epilepsy.
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Affiliation(s)
- Uliana Boldyreva
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Peter L Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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14
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Hussain SR, Orwa J, Sokhi DS, Kathomi CM, Dossajee H, Miyanji O, Ngugi A, Samia P. Determining the quality of life of children living with epilepsy in Kenya-A cross-sectional study using the CHEQOL-25 tool. Seizure 2020; 76:100-104. [PMID: 32059170 DOI: 10.1016/j.seizure.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/01/2020] [Accepted: 01/11/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Epilepsy is a chronic neurological disorder that is often diagnosed in childhood and may negatively impact physical, social and psychological abilities. Most tools measuring quality of life (QoL) rely on parent/caregiver feedback rather than the child's perspective. CHEQOL-25 is a QoL tool that documents both child and caregiver perspectives across five domains. The primary objective was to determine the QoL of children living with epilepsy (CWE) using the CHEQOL-25 tool in a Kenyan paediatric population. Other objectives were to describe the correlation between the caregivers' and children's' perspectives and describe factors affecting QoL. METHOD We conducted a cross-sectional study across four sites in Nairobi. Quantitative data was collected using a self-administered CHEQOL-25 questionnaire. Caregivers and their children aged 7-15 years attending neurology clinics participated in the study. We used Kappa statistics to compare child and caregiver responses. RESULTS A total of 354 participants were interviewed (177 children and 177 caregivers). A good QoL was reported by 60.5 % of children with a similar caregiver perception of 56.5 %. Caregivers with little education and male caregivers were associated with a poor QoL (p = 0.01); other socio-demographic factors had little impact on the measured QoL of CWE. Parent and child questionnaires correlated well in terms of response in terms of interpersonal (p = 0.001) and intrapersonal (p = 0.004) domains. CONCLUSION This study demonstrated that a good quality of life was reported by the majority of CWE and their caregivers, although some factors such as a male caregiver gender and lower level of education were associated with poor QoL.
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Affiliation(s)
- Syeda Ra'ana Hussain
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
| | - James Orwa
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
| | - Dilraj Singh Sokhi
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
| | - Caroline Mbuba Kathomi
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
| | | | - Osman Miyanji
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya; Kenya Association for the Welfare of People Living with Epilepsy (KAWE), P. O. Box 60790-00200, Nairobi, Kenya.
| | - Anthony Ngugi
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya
| | - Pauline Samia
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
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15
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16
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Bashir MBA, Abdalla SM, Nkfusai NC, Nsai FS, Cumber RY, Tsoka-Gwegweni JM, Cumber SN. Stigma on epileptic patients attending the outpatient clinic of Soba University Hospital and the National Center for Neurological Science (NCNS) Khartoum, Sudan. Pan Afr Med J 2019; 32:93. [PMID: 31223384 PMCID: PMC6560985 DOI: 10.11604/pamj.2019.32.93.17511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/29/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Epilepsy is one of the most prevalent neurological conditions for people of different age group, race, gender and socio-economic status in various nations, affecting 50 million people around the world; 80% of them living in developing countries. In Sudan, literature has well documented epilepsy stigma and it related elements of labelling, negative typecasting, isolation, devaluing and discrimination that are significantly affecting patients living standards and social life. This study focuses on understanding the prevailing, different types of stigma among people living with epilepsy (PWE) in Sudan and to determine its frequency in connection with demographic factors and patients coping ability of PWE. Methods A health facility-based cross-sectional descriptive study was conducted on 270 people between the ages of 16-70years who are affected by epilepsy in an outpatient clinic. Standardized questionnaires were used to interview the patients with assistance gotten from their relative where necessary. The data is analyzed using SPSS version 20. The study was conducted in the outpatient clinic of The National Center for Neurological Sciences (NCNS), Ibrahim-Malik Teaching Hospital Sudan. Results The study realized that 16.6% of the patient had a positive self-stigma score, half of them having coaching stigma and 25% courtesy stigma. One third of people with epilepsy had poor coping score that was strongly determined by self- stigma and courtesy stigma score. Conclusion Parents and relatives related sigma is a major problem facing people of epilepsy in Sudan; thus, raising such group awareness and education about the disease can markedly improve the quality of life of people with epilepsy in Sudan.
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Affiliation(s)
- Muwada Bashir Awad Bashir
- Discipline of Medicine and Surgery, Faculty of Medicine University of Khartoum, Kkartoun, Sudan.,Section for Epidemiology and Social Medicine, Department of Public Health, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Shahd Mohammed Abdalla
- Discipline of Medicine and Surgery, Faculty of Medicine University of Khartoum, Kkartoun, Sudan
| | - Ngwayu Claude Nkfusai
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.,HIV Free Project, Center Region, Cameroon Baptist Convention with Funds from PEPFAR through CDC Atlanta, USA
| | - Frankline Sanyuy Nsai
- HIV Free Project, Center Region, Cameroon Baptist Convention with Funds from PEPFAR through CDC Atlanta, USA.,Department of Public Health, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Joyce Mahlako Tsoka-Gwegweni
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal Durban, South Africa.,Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Samuel Nambile Cumber
- Section for Epidemiology and Social Medicine, Department of Public Health, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Exploring the needs and challenges of parents and their children in childhood epilepsy care: A qualitative study. Epilepsy Behav 2018; 88:268-276. [PMID: 30321756 DOI: 10.1016/j.yebeh.2018.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/15/2018] [Accepted: 09/16/2018] [Indexed: 11/23/2022]
Abstract
Because of the nature of epilepsy, and the unpredictability of seizure recurrence, epilepsy requires long-term treatment with medications. As a consequence, epilepsy has a negative pervasive impact in children with epilepsy (CWE), and their parents. Hence, our aim was to explore the needs and challenges of parents and their CWE. In-depth interviews (IDIs) were conducted with 15 families (12 mothers and 3 fathers) and 15 CWE (aged 8-18 years). Data were transcribed verbatim and thematically analyzed using the descriptive phenomenology approach. The experiences of parents and their CWE could be divided into two time frames: "experiences during a child's first seizure" and "experiences whilst growing up with epilepsy". Parents' main concerns and worries were regarding their child's physical health, psychological and emotional wellbeing, academic achievement, and future. The children's main concerns were restrictions imposed, their interpersonal relationship with peers, and being independent in the future. Parents reported that they needed epilepsy-related information, continuity of care, and a parental support group, while CWE reported that their main needs were independence and autonomy. The views of parents and their child with epilepsy were similar in physical functioning and academic achievement. However, parents and children had different views on how epilepsy impacted on the child emotionally, as well as behavioral and interpersonal relationship with peers.
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18
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Ronen GM, Rosenbaum PL, Boyle MH, Streiner DL. Patient-reported quality of life and biopsychosocial health outcomes in pediatric epilepsy: An update for healthcare providers. Epilepsy Behav 2018; 86:19-24. [PMID: 30036765 DOI: 10.1016/j.yebeh.2018.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
In the 21st century, clinicians are expected to listen to, and understand their patients' views about, their conditions and the effects that these conditions have on their functioning, values, life goals, and welfare. The goals of this review are as follows: (i) to inform, update, and guide clinicians caring for children with epilepsy about developments in the content and new methods of research on patient-reported outcomes, quality of life, and functioning; and (ii) to discuss the value of using these concepts to explore the impact of diverse interventions that are implemented in daily practice. Drawing on the literature and our program of research over the past two decades, we focus on our current understanding of a variety of health concepts and recently acquired knowledge about their significance for the lives of patients and their families. We discuss the advantages of measuring patient-reported outcomes that tell us what is important to patients. We advise on what characteristics to look for when choosing a patient-reported measure, and the relevance of these considerations. In addition, we address gaps in research knowledge and the causes of confusion that have limited their use in our daily clinical practice.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada.
| | - Peter L Rosenbaum
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
| | - Michael H Boyle
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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19
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Bilgiç A, Işık Ü, Sivri Çolak R, Derin H, Çaksen H. Psychiatric symptoms and health-related quality of life in children with epilepsy and their mothers. Epilepsy Behav 2018; 80:114-121. [PMID: 29414540 DOI: 10.1016/j.yebeh.2017.12.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/23/2017] [Accepted: 12/23/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE This study evaluated the psychiatric symptoms and health-related quality of life (HRQL) of children with epilepsy and psychiatric symptoms of their mothers, and compared them to those of healthy children and their mothers. This study also explored the influence of the child-related and maternal psychiatric variables and seizure-specific factors on the HRQLs of children with epilepsy according to both the children's and parents' perspectives. METHOD Ninety-nine children with epilepsy (8 to 17years old), their mothers, and a control group (n=51) participated in this study. The depression and anxiety symptoms of the children were assessed using the Child Depression Inventory (CDI) and the Screen for Child Anxiety-Related Emotional Disorders (SCARED), respectively. The severities of the attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms were assessed via the mother-rated Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S). In addition, the mothers completed the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to assess their depression and anxiety symptoms, respectively. Child-reported and parent-reported Pediatric Quality of Life Inventories were used to evaluate the HRQLs of the children. RESULTS The patients exhibited higher inattention and ODD scores than the controls did. With the exception of the child-reported physical health scores, all of the child- and parent-reported HRQL scores were significantly lower in the patient group. According to the regression analysis, the child-related psychiatric and seizure-specific factors, but not the maternal psychiatric factors, were associated with the child's HRQL. The explained variances for the overall HRQL and HRQL subscales were similar between the child-reported (0.373 to 0.654) and parent-reported (0.499 to 0.682) questionnaires. The largest contributors to the total variance were the child-related psychiatric factors for both the child-reported and parent-reported HRQLs by far. CONCLUSION Epilepsy is associated with a poor psychiatric status and HRQL in childhood. The impact of epilepsy on the HRQL occurs mainly through child-related psychiatric factors. Both the child-reported and parent-reported questionnaires seem to be useful for the evaluation of the HRQL in pediatric epilepsy cases.
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Affiliation(s)
- Ayhan Bilgiç
- Necmettin Erbakan University, Meram School of Medicine, Department of Child and Adolescent Psychiatry, Turkey.
| | - Ümit Işık
- Yozgat State Hospital, Department of Child and Adolescent Psychiatry, Turkey
| | - Rukiye Sivri Çolak
- Ankara Education and Research Hospital, Department of Child and Adolescent Psychiatry, Turkey
| | - Hatice Derin
- Necmettin Erbakan University, Meram School of Medicine, Department of Child Neurology, Turkey
| | - Hüseyin Çaksen
- Necmettin Erbakan University, Meram School of Medicine, Department of Child Neurology, Turkey
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20
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Fong CY, Chang WM, Kong AN, Rithauddin AM, Khoo TB, Ong LC. Quality of life in Malaysian children with epilepsy. Epilepsy Behav 2018; 80:15-20. [PMID: 29396357 DOI: 10.1016/j.yebeh.2017.12.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/24/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Children with epilepsy (CWE) are at risk of impaired quality of life (QOL), and achieving a good QOL is an important treatment goal among CWE. To date, there are no published multiethnic QOL studies in Asia. Our study aimed to: i) investigate the QOL of multiethnic CWE in Malaysia as reported by both the child and parent; ii) determine the level of agreement between child-self report and parent-proxy report QOL; and iii) explore potential correlates of sociodemographic, epilepsy characteristics, and family functioning with QOL in CWE. METHODS Cross-sectional study of all CWE aged 8-18years old with at least 6months' duration of epilepsy, minimum reading level of primary school education Year 1, and attending mainstream education. Quality of life was measured using the parent-proxy and child self-report of Quality of Life Measurement for Children with Epilepsy (CHEQOL-25) questionnaire. Total and subscale CHEQOL-25 scores were obtained. The levels of parent-child agreement were determined using intraclass correlation coefficients (ICC). Family functioning was assessed using the General functioning subscale (GF-12). RESULTS A total of 115 CWE and their parents participated in the study. In general, Malaysian parents rated children's total CHEQOL-25 scores poorer than the children themselves [mean total parent score: 68.56 (SD: 10.86); mean total child score: 71.82 (SD: 9.55)]. Agreement between child and parent on the CHEQOL-25 was poor to moderate (ICC ranged from 0.31-0.54), with greatest discordance in the epilepsy secrecy domain (ICC=0.31, p=0.026). Parent and child were more likely to agree on more external domains: intrapersonal/social (ICC=0.54, p<0.001) and interpersonal/emotional (ICC=0.50, p<0.001). Malay ethnicity, focal seizure and high seizure frequency (≥1 seizure per month) were associated with lower CHEQOL-25 scores. There was a significant but weak correlation between GF-12 and parent-proxy CHEQOL-25 Total Scores (r=-0.186, p=0.046). CONCLUSION Our results emphasize the importance to have the child's perspective of their QOL as the level of agreement between the parent and child reported scores were poor to moderate. Malaysian CWE of Malay ethnicity, those with focal seizures or high seizure frequency are at risk of poorer QOL.
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Affiliation(s)
- Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
| | - Wei Mun Chang
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Paediatric Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Ann Nie Kong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | - Teik Beng Khoo
- Paediatric Neurology Unit, Paediatric Institute, Hospital Kuala Lumpur, Malaysia
| | - Lai Choo Ong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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21
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Mendes TP, Crespo CA, Austin JK. The psychological costs of comparisons: Parents' social comparison moderates the links between family management of epilepsy and children's outcomes. Epilepsy Behav 2017; 75:42-49. [PMID: 28826008 DOI: 10.1016/j.yebeh.2017.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
Parents play a key role in how children deal with epilepsy. When diagnosed with health conditions, people seek comparison information from fellow patients and families, and this information has consequences for how they evaluate their situation. This study examined the moderating role of parents' social comparison orientation in the associations between family management (parental perceptions of family life difficulties and child's daily life) and adaptation outcomes of children with epilepsy (HRQoL and perceived stigma). Participants included 201 dyads of children with epilepsy and either their mother or father. The results showed that when parents perceived higher difficulties managing their child's epilepsy and/or reported that their child was more affected by this condition, children reported higher perceived stigma and worse HRQoL only when parents had a higher social comparison orientation. Our results are innovative in showing that when parents have a higher social comparison orientation, their children may be at increased risk of poorer outcomes.
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Affiliation(s)
- Teresa P Mendes
- Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, Portugal.
| | - Carla A Crespo
- Faculdade de Psicologia, Universidade de Lisboa, Portugal
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Ferro MA, Avery L, Fayed N, Streiner DL, Cunningham CE, Boyle MH, Lach L, Glidden G, Rosenbaum PL, Ronen GM. Child- and parent-reported quality of life trajectories in children with epilepsy: A prospective cohort study. Epilepsia 2017; 58:1277-1286. [PMID: 28485850 DOI: 10.1111/epi.13774] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the developmental trajectories of quality of life (QoL) in a large cohort of children with epilepsy, and to assess the relative contribution of clinical, psychosocial, and sociodemographic variables on QoL trajectories. METHODS Five assessments during a 28-month prospective cohort study were used to model trajectories of QoL. Participants were recruited with their parents from six Canadian tertiary centers. A convenience sample of 506 children aged 8-14 years with epilepsy and without intellectual disability or autism spectrum disorder were enrolled. A total of 894 children were eligible and 330 refused participation. Participating children were, on average, 11.4 years of age, and 49% were female. Nearly one third (32%) had partial seizures. At baseline, 479 and 503 child- and parent-reported questionnaires were completed. In total, 354 children (74%) and 366 parents (73%) completed the 28-month follow-up. QoL was measured using the child- and parent-reported version of the Childhood Epilepsy QoL scale (CHEQOL-25). RESULTS Child-reported QoL was fitted best by a six-class model and parent-reported QoL by a five-class model. In both models, trajectories remained either stable or improved over 28 months. Of these children, 62% rated their QoL as high or moderately high, defined as at least one standard deviation above the average CHEQOL-25 score. Greater family, classmate, and peer social support, fewer symptoms of child and parent depression, and higher receptive vocabulary were identified as the most robust predictors of better QoL (all p < 0.001). SIGNIFICANCE Most children with epilepsy and their parents reported relatively good QoL in this first joint self- and proxy-reported trajectory study. Findings confirm the heterogeneous QoL outcomes for children with epilepsy and the primary importance of psychosocial factors rather than seizure and AED-specific factors in influencing QoL. These predictors that are potentially amenable to change should now be the focus of specific intervention studies.
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Affiliation(s)
- Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Lisa Avery
- Avery Information Services, Orillia, Ontario, Canada
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Charles E Cunningham
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Boyle
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lucyna Lach
- School of Social Work, McGill University, Montreal, Ontario, Canada
| | - Gina Glidden
- School of Social Work, McGill University, Montreal, Ontario, Canada
| | - Peter L Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Iqbal M, Amirsalari S, Radfar S, Haidari MR. Effects of parental gender and level of education on the quality of life and general health of pediatric patients with epilepsy: An outpatient cross-sectional survey. Epilepsy Behav 2016; 60:118-123. [PMID: 27206229 DOI: 10.1016/j.yebeh.2016.04.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
The quality of life (QOL) of children with epilepsy has been widely studied, and several problems related to cognition, behavior, social lives, and physical activity among these children have been reported. Family life and parental care are important aspects of the lives of these patients. The impact of parental education on the QOL of pediatric patients with epilepsy is an understudied topic, especially in developing countries. In this study, we investigated the QOL and general health (GH) of patients with epilepsy presenting at the pediatric neurology clinic at Baqiyatallah Hospital and a private clinic. The Quality of Life in Childhood Epilepsy (QOLCE) questionnaire, which is a 92-item epilepsy-specific questionnaire covering physical activity, well-being, cognition, behavior, social activity, overall QOL, and GH, was used for interviewing parents. A total of 106 patients (m=61, 57.5% and f=45, 42.5%) aged 5-17years (mean: 10.31±2.91) participated in the study. Overall, there was no significant difference between the QOL and GH results of male and female patients. However, the maternal education level had a significant impact on the overall QOL (high school: 3.02±0.85 vs. B.Sc.: 3.67±0.61, p<0.05) and GH (high school: 2.81±0.79 vs. B.Sc.: 3.8±0.94, p<0.05) of male patients, while paternal education had no significant effect. A multiple linear regression showed that the maternal education level had an independently significant association with the physical activity of the patients (p=0.02, CI: 1.4-6.25), and the paternal education level had an independently significant association with the well-being of the patients (p=0.02, CI: 0.43-5.36). In addition, the maternal education level (high school vs. B.Sc.) had a significant effect on physical activity, well-being, cognition, and behavior for all of the patients (p<0.05), while the paternal education level (high school vs. B.Sc.) had no significant impact. However, in a comparison of high school vs. higher education, paternal education had a significant effect on patients' physical activity and well-being (p<0.05). We conclude that parental levels of education play a significant role in various aspects of the lives and GH of children with epilepsy. Maternal education, in particular, plays a significant role in GH and the overall QOL of male patients. Further research is suggested to identify the socioeconomic and cultural factors responsible for these findings.
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Affiliation(s)
- Meisam Iqbal
- Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Susan Amirsalari
- Department of Paediatrics, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Shokofeh Radfar
- Department of Psychiatry, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohsen Reza Haidari
- Section of Neuroscience, Department of Neurology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran.
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Harden J, Black R, Chin RFM. Families' experiences of living with pediatric epilepsy: A qualitative systematic review. Epilepsy Behav 2016; 60:225-237. [PMID: 27240309 DOI: 10.1016/j.yebeh.2016.04.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/05/2016] [Accepted: 04/18/2016] [Indexed: 12/27/2022]
Abstract
Living with epilepsy in childhood has implications for the child and their family beyond the physical effects associated with epileptic seizures. Qualitative research has emerged, aiming to deliver a greater depth of understanding of the experiences of living with epilepsy from the perspectives of children with epilepsy, their parents, and their siblings. This review of qualitative research had three aims: first, to synthesize the demographic and epilepsy profiles of research participants in eligible studies in order to provide a clear picture of who are included and excluded when studying families' experiences; second, to present and discuss the methodological concerns and implications of research involving children with epilepsy; and third, to synthesize the findings arising from qualitative research with families in order to identify common themes across all relevant studies to date. Papers published in the English language prior to January 2016 were identified following a search of eight electronic databases: Embase, Psychinfo, Medline, CINAHL, Web of Knowledge, ASSIA, Web of Science, and SCOPUS. Studies were included if they involved a sample of children with epilepsy (up to 18years of age), parents, or siblings of children with epilepsy and used qualitative methods. Twenty-one studies were identified as eligible for inclusion in the review. Findings in relation to the three aims were the following: 1) Researchers were seeking an understanding of children's experiences directly from children rather than by parental proxy. However, children with learning disabilities were often excluded from research, meaning that their views are not being heard. Parental research was predominantly with mothers, and father experiences were not often accessed. There was very little research with siblings. 2) The rationale for and ethical implications of the choice of research methods adopted were not always clear, and not all studies gave adequate attention to the development of appropriate methods for research involving children. 3) Two dominant themes emerged across the studies: normalcy and children's agency. Cutting across many of the challenges that living with epilepsy presented was the desire (by parents and children) for a 'normal' childhood. The studies also highlighted that children have knowledge about their own condition and epilepsy more generally and that they are involved in managing the ways in which they cope with epilepsy, both in terms of seizure prevention and managing their relations with others, particularly peers. Future research should ensure that appropriate design, data collection, and analytic strategies are adopted to facilitate the participation of all family members. Enhancing the quality of the research will, in turn, optimize validity and opportunities for the translation of findings into better health, education, and social practices to improve care for children and their families affected by epilepsy.
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Affiliation(s)
- Jeni Harden
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, EH8 9LG, UK; Muir Maxwell Epilepsy Centre, University of Edinburgh, Sylvan Place, EH9 1UW, UK.
| | - Rebecca Black
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Sylvan Place, EH9 1UW, UK; Child Life and Health, University of Edinburgh, Sylvan Place, EH9 1UW, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Sylvan Place, EH9 1UW, UK; Child Life and Health, University of Edinburgh, Sylvan Place, EH9 1UW, UK
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Ferro MA, Goodwin SW, Sabaz M, Speechley KN. Measurement equivalence of the newly developed Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55). Epilepsia 2016; 57:427-35. [DOI: 10.1111/epi.13296] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Mark A. Ferro
- Department of Psychiatry and Behavioural Neurosciences; McMaster University; Hamilton Ontario Canada
- Department of Pediatrics; McMaster University; Hamilton Ontario Canada
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton Ontario Canada
- Offord Centre for Child Studies; McMaster University; Hamilton Ontario Canada
| | - Shane W. Goodwin
- Department of Epidemiology and Biostatistics; Western University; London Ontario Canada
- Children's Health Research Institute; Lawson Health Research Institute; London Ontario Canada
| | - Mark Sabaz
- Department of Psychology; Sydney Children's Hospital (Randwick); Randwick New South Wales Australia
| | - Kathy N. Speechley
- Department of Epidemiology and Biostatistics; Western University; London Ontario Canada
- Children's Health Research Institute; Lawson Health Research Institute; London Ontario Canada
- Department of Paediatrics; Western University; London Ontario Canada
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Murugupillai R, Wanigasinghe J, Muniyandi R, Arambepola C. Parental concerns towards children and adolescents with epilepsy in Sri Lanka—Qualitative study. Seizure 2016; 34:6-11. [DOI: 10.1016/j.seizure.2015.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022] Open
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Quality of life in children with epilepsy: How does it compare with the quality of life in typical children and children with cerebral palsy? Epilepsy Behav 2015; 52:239-43. [PMID: 26469801 DOI: 10.1016/j.yebeh.2015.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/03/2015] [Accepted: 09/12/2015] [Indexed: 11/24/2022]
Abstract
Our objective was to compare the quality of life (QoL) of children with epilepsy to that of typical children and children with cerebral palsy (CP). We measured self- and proxy-reported QoL of children with epilepsy and contrasted that with data for typical children (European KIDSCREEN project) and children with CP (SPARCLE study). Children ages 8-12 years with epilepsy were recruited from six Canadian sites. Same-aged children with CP and children in the general population aged 8-11 years came from several European countries. All participants completed the KIDSCREEN-52 questionnaire. Our results showed no clinically important differences (>0.5 SD) between self-reported QoL in 345 children with epilepsy compared with 489 children with CP or 5950 children in the general population. However, parents reported clinically important differences between the epilepsy and the other groups in five KIDSCREEN-52 domains. Compared with the CP group, parents of children with epilepsy reported better QoL in physical well-being (Cohen d=0.81), social support (d=0.80), and autonomy (d=0.72). Parents reported poorer QoL in the domains of mood and emotions compared with both contrast groups (d=-0.72 and d=-0.53), and in the domain of bullying compared with the CP group (d=-0.51). Families should find comfort in the results, which indicate that children with epilepsy do not perceive any important differences in QoL compared with their typical peers. The comparisons of parental reports detect their group-specific observations and worries that need to be addressed by the health-care providers and may require specifically designed assessment batteries followed by appropriate interventions.
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Fayed N, Davis AM, Streiner DL, Rosenbaum PL, Cunningham CE, Lach LM, Boyle MH, Ronen GM. Children's perspective of quality of life in epilepsy. Neurology 2015; 84:1830-7. [PMID: 25841031 PMCID: PMC4433469 DOI: 10.1212/wnl.0000000000001536] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/05/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study child mental health, parental support, and social support of children with epilepsy as these relate to quality of life (QOL) using child self-report, seizure-related variables, and estimated verbal intelligence based on receptive vocabulary. METHODS A cross-sectional structural equation model of baseline data from the QUALITÉ cohort study, which includes 6 Canadian child epilepsy ambulatory programs. A sample of 3,481 children were screened for the following eligibility: 8 to 14 years of age, with active or medication-managed epilepsy. Of 894 eligible children, 506 agreed to participate, of whom 26 were then excluded because of an inability to self-report based on a standard cutoff score of receptive vocabulary lower than 70. The primary outcome of child-reported QOL was measured using the Child Epilepsy QOL Questionnaire. RESULTS From the child's perspective, epilepsy-specific QOL is strongly related to their mental health and social support but not to their seizures. Specifically, child mental health and peer support exhibit direct associations with QOL; parental support has both direct and indirect associations with QOL (via child mental health); estimated verbal intelligence exerts its strongest association with QOL through mental health; and seizure status exhibits a weak relationship to QOL only through mental health. CONCLUSIONS Among children with epilepsy aged 8 to 14 years, mental health and social support should be areas of focus in the assessment of QOL. Controlling seizures is insufficient care for influencing the child's perception of their life.
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Affiliation(s)
- Nora Fayed
- From Health Care and Outcomes Research (N.F., A.M.D.), University Health Network, Toronto; Departments of Pediatrics (N.F., P.L.R., G.M.R.) and Psychiatry & Behavioural Neurosciences (D.L.S., C.E.C., M.H.B.), CanChild Centre for Childhood Disability Research (N.F., P.L.R., G.M.R.), and Offord Centre for Child Studies (C.E.C., M.H.B.), McMaster University, Hamilton; Institute of Health Policy Management and Evaluation (A.M.D.), Graduate Department of Rehabilitation Science (A.M.D.), and Department of Psychiatry (D.L.S.), University of Toronto; and School of Social Work (L.M.L.) McGill University, Montreal, Canada.
| | - Aileen M Davis
- From Health Care and Outcomes Research (N.F., A.M.D.), University Health Network, Toronto; Departments of Pediatrics (N.F., P.L.R., G.M.R.) and Psychiatry & Behavioural Neurosciences (D.L.S., C.E.C., M.H.B.), CanChild Centre for Childhood Disability Research (N.F., P.L.R., G.M.R.), and Offord Centre for Child Studies (C.E.C., M.H.B.), McMaster University, Hamilton; Institute of Health Policy Management and Evaluation (A.M.D.), Graduate Department of Rehabilitation Science (A.M.D.), and Department of Psychiatry (D.L.S.), University of Toronto; and School of Social Work (L.M.L.) McGill University, Montreal, Canada
| | - David L Streiner
- From Health Care and Outcomes Research (N.F., A.M.D.), University Health Network, Toronto; Departments of Pediatrics (N.F., P.L.R., G.M.R.) and Psychiatry & Behavioural Neurosciences (D.L.S., C.E.C., M.H.B.), CanChild Centre for Childhood Disability Research (N.F., P.L.R., G.M.R.), and Offord Centre for Child Studies (C.E.C., M.H.B.), McMaster University, Hamilton; Institute of Health Policy Management and Evaluation (A.M.D.), Graduate Department of Rehabilitation Science (A.M.D.), and Department of Psychiatry (D.L.S.), University of Toronto; and School of Social Work (L.M.L.) McGill University, Montreal, Canada
| | - Peter L Rosenbaum
- From Health Care and Outcomes Research (N.F., A.M.D.), University Health Network, Toronto; Departments of Pediatrics (N.F., P.L.R., G.M.R.) and Psychiatry & Behavioural Neurosciences (D.L.S., C.E.C., M.H.B.), CanChild Centre for Childhood Disability Research (N.F., P.L.R., G.M.R.), and Offord Centre for Child Studies (C.E.C., M.H.B.), McMaster University, Hamilton; Institute of Health Policy Management and Evaluation (A.M.D.), Graduate Department of Rehabilitation Science (A.M.D.), and Department of Psychiatry (D.L.S.), University of Toronto; and School of Social Work (L.M.L.) McGill University, Montreal, Canada
| | - Charles E Cunningham
- From Health Care and Outcomes Research (N.F., A.M.D.), University Health Network, Toronto; Departments of Pediatrics (N.F., P.L.R., G.M.R.) and Psychiatry & Behavioural Neurosciences (D.L.S., C.E.C., M.H.B.), CanChild Centre for Childhood Disability Research (N.F., P.L.R., G.M.R.), and Offord Centre for Child Studies (C.E.C., M.H.B.), McMaster University, Hamilton; Institute of Health Policy Management and Evaluation (A.M.D.), Graduate Department of Rehabilitation Science (A.M.D.), and Department of Psychiatry (D.L.S.), University of Toronto; and School of Social Work (L.M.L.) McGill University, Montreal, Canada
| | - Lucyna M Lach
- From Health Care and Outcomes Research (N.F., A.M.D.), University Health Network, Toronto; Departments of Pediatrics (N.F., P.L.R., G.M.R.) and Psychiatry & Behavioural Neurosciences (D.L.S., C.E.C., M.H.B.), CanChild Centre for Childhood Disability Research (N.F., P.L.R., G.M.R.), and Offord Centre for Child Studies (C.E.C., M.H.B.), McMaster University, Hamilton; Institute of Health Policy Management and Evaluation (A.M.D.), Graduate Department of Rehabilitation Science (A.M.D.), and Department of Psychiatry (D.L.S.), University of Toronto; and School of Social Work (L.M.L.) McGill University, Montreal, Canada
| | - Michael H Boyle
- From Health Care and Outcomes Research (N.F., A.M.D.), University Health Network, Toronto; Departments of Pediatrics (N.F., P.L.R., G.M.R.) and Psychiatry & Behavioural Neurosciences (D.L.S., C.E.C., M.H.B.), CanChild Centre for Childhood Disability Research (N.F., P.L.R., G.M.R.), and Offord Centre for Child Studies (C.E.C., M.H.B.), McMaster University, Hamilton; Institute of Health Policy Management and Evaluation (A.M.D.), Graduate Department of Rehabilitation Science (A.M.D.), and Department of Psychiatry (D.L.S.), University of Toronto; and School of Social Work (L.M.L.) McGill University, Montreal, Canada
| | - Gabriel M Ronen
- From Health Care and Outcomes Research (N.F., A.M.D.), University Health Network, Toronto; Departments of Pediatrics (N.F., P.L.R., G.M.R.) and Psychiatry & Behavioural Neurosciences (D.L.S., C.E.C., M.H.B.), CanChild Centre for Childhood Disability Research (N.F., P.L.R., G.M.R.), and Offord Centre for Child Studies (C.E.C., M.H.B.), McMaster University, Hamilton; Institute of Health Policy Management and Evaluation (A.M.D.), Graduate Department of Rehabilitation Science (A.M.D.), and Department of Psychiatry (D.L.S.), University of Toronto; and School of Social Work (L.M.L.) McGill University, Montreal, Canada
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Reilly C, Atkinson P, Das KB, Chin RFM, Aylett SE, Burch V, Gillberg C, Scott RC, Neville BGR. Factors associated with quality of life in active childhood epilepsy: a population-based study. Eur J Paediatr Neurol 2015; 19:308-13. [PMID: 25596900 DOI: 10.1016/j.ejpn.2014.12.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/27/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Improving health-related quality of life (HRQOL), rather than just reducing seizures, should be the principal goal in comprehensive management of childhood epilepsy. There is a lack of population-based data on predictors of HRQOL in childhood epilepsy. METHODS The Children with Epilepsy in Sussex Schools (CHESS) study is a prospective, population-based study involving school-aged children (5-15 years) with active epilepsy (on one or more AED and/or had a seizure in the last year) in a defined geographical area in the UK. Eighty-five of 115 (74% of eligible population) children underwent comprehensive psychological assessment including measures of cognition, behaviour, and motor functioning. Parents of the children completed the Quality of Life in Childhood Epilepsy (QOLCE).Clinical data on eligible children was extracted using a standardised pro forma. Linear regression analysis was undertaken to identify factors significantly associated with total Quality of Life in this population. RESULTS Factors independently significantly associated (p < .05) with total QOLCE scores were seizures before 24 months, cognitive impairment (IQ < 85), anxiety, and parent reported school attendance difficulty. These factors were also significantly associated with total QOLCE when children with IQ < 50 were excluded from analysis. CONCLUSIONS The majority of factors associated with parent reported HRQOL in active childhood epilepsy are related to neurobehavioural and/or psychosocial aspects of the condition.
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Affiliation(s)
- Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; Gillberg Neuropsychiatry Centre, University of Gothenburg, Kungsgatan 12, Gothenburg, Sweden.
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, West Green Drive, Crawley, RH11 7DH, West Sussex, UK
| | - Krishna B Das
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, Edinburgh Neurosciences, The University of Edinburgh, Edinburgh, UK
| | - Sarah E Aylett
- Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Victoria Burch
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Kungsgatan 12, Gothenburg, Sweden; Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK
| | - Rod C Scott
- College of Medicine, University of Vermont, Burlington, VT, 05405, USA; Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Brian G R Neville
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK
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30
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Ferro MA. Risk factors for health-related quality of life in children with epilepsy: A meta-analysis. Epilepsia 2014; 55:1722-31. [DOI: 10.1111/epi.12772] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Mark A. Ferro
- Psychiatry & Behavioural Neurosciences; McMaster University; Hamilton Ontario Canada
- Pediatrics; McMaster University; Hamilton Ontario Canada
- Clinical Epidemiology & Biostatistics; McMaster University; Hamilton Ontario Canada
- Offord Centre for Child Studies; McMaster University; Hamilton Ontario Canada
- CanChild Centre for Childhood Disability Research; McMaster University; Hamilton Ontario Canada
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Thomson L, Fayed N, Sedarous F, Ronen GM. Life quality and health in adolescents and emerging adults with epilepsy during the years of transition: a scoping review. Dev Med Child Neurol 2014; 56:421-33. [PMID: 24237329 DOI: 10.1111/dmcn.12335] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/29/2022]
Abstract
AIMS The aims of this study were to (1) search the literature in order to identify the challenges facing adolescents and emerging adults with epilepsy; and (2) categorize these issues within both the framework of the International Classification of Functioning, Disability and Health (ICF) and an empirical model of quality of life (QOL) in childhood epilepsy. METHOD We systematically searched PsycINFO, Ovid MEDLINE and Web of Science for studies reporting on QOL and health identified in people with epilepsy aged 12 to 29 years. Studies were limited to those that were published in the last 20 years in English, presenting the patient perspective. Data were extracted and charted using a descriptive analytical method. Identified issues were classified according to the ICF and QOL frameworks. RESULTS Fifty four studies were identified. Another 62 studies with potentially useful information were included as an addendum. The studies highlight a range of psychosocial issues emphasizing peer acceptance, social isolation, and feelings of anxiety, fear, and sadness. INTERPRETATION The ICF and QOL constructs represent useful starting points in the analytical classification of the potential challenges faced by adolescents with epilepsy. Progress is needed on fully classifying issues not included under these frameworks. We propose to expand these frameworks to include comorbidities, impending medical interventions, and concerns for future education, employment, marriage, dignity, and autonomy.
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Affiliation(s)
- Lauren Thomson
- Undergraduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Psychometric properties of the modified Czech version of the children self-report Quality-of-life Measure for Children with Epilepsy (CHEQOL-25). Epilepsy Behav 2014; 33:31-8. [PMID: 24614523 DOI: 10.1016/j.yebeh.2014.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/31/2014] [Accepted: 02/08/2014] [Indexed: 11/22/2022]
Abstract
Quality of life (QoL) is a crucial factor in the treatment of individuals suffering from epilepsy. We aimed to adapt the children's version of the CHEQOL-25 questionnaire to allow the QoL measurement in children suffering from epilepsy in the Czech Republic. The adaptation was conducted on a group of 250 children and adolescents aged 8-15years. It was found that the questionnaire required modification to fit the Czech pediatric population. Indirect questions were changed to direct questions, and two items were omitted from the original version of the questionnaire. The reasons for these modifications are discussed. The modified questionnaire was subjected to exploratory factor analysis, and a 4-factor structure was favored over the 5-factor structure of the original version. The internal consistency measured using Cronbach's alpha was found to be in the range of 0.78-0.83 for the individual scales, and test-retest reliability was expressed using intraclass correlation coefficient which was found to be in the range of 0.65-0.75. The modified Czech version of the CHEQOL-25 questionnaire displayed very good results with regard to construct validity. Its strength is its simplicity and clarity which allows it to be used in children with impaired cognitive functions. The results showed that the modified version of the Czech CHEQOL-25 has very good psychometric properties and could be used in further research and clinical practice.
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Healthcare utilization and costs in children with stable and uncontrolled epilepsy. Epilepsy Behav 2014; 32:135-41. [PMID: 24561658 DOI: 10.1016/j.yebeh.2014.01.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Epilepsy adversely affects childhood development, possibly leading to increased economic burden in pediatric populations. We compared annual healthcare utilization and costs between children (<12 years old) with stable and uncontrolled epilepsy treated with antiepileptic drugs (AEDs). METHODS Children (<12 years old) with epilepsy (ICD-9-CM 345.xx or 780.39) in 2008 were identified in the MarketScan claims database from 2007 to 2009. Patients with "stable" epilepsy used the same AED for ≥12 months, and patients with "uncontrolled" epilepsy were prescribed additional AED(s) during that period. For patients with uncontrolled epilepsy, the study index date was the start of additional AED(s); for patients with stable epilepsy, the study index date was a random AED fill date. Epilepsy-related utilization included medical services with 345.xx or 780.39 in any diagnosis field and AED fills. Epilepsy-related costs included AEDs, medical claims with epilepsy in any diagnosis field, and certain tests. We adjusted for baseline cohort differences (demographics, region, usual-care physician specialty, and comorbidities) using logistic regression and analysis of covariance. RESULTS Two thousand one hundred seventy patients were identified (mean: 7.5 years; 45.3% were female; Charlson comorbidity index: 0.3; 422 (19.4%) patients with uncontrolled epilepsy). Patients with uncontrolled epilepsy faced more hospitalizations (30.1% vs. 12.0%) and greater overall ($30,343 vs. $18,206) and epilepsy-related costs ($16,894 vs. $7979) (all p<.001). Adjusting for baseline measures, patients with uncontrolled epilepsy had greater odds of hospitalization (OR: 2.5; 95% CI: 1.9-3.3) and costs (overall: $3908, p=.087; epilepsy-related: $5744, p<.001). CONCLUSIONS Children with uncontrolled epilepsy use significantly more healthcare resources and have a greater economic burden than children with stable epilepsy. However, epilepsy accounted for only half of overall costs, indicating that comorbid conditions may add substantially to the disease burden.
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Ronen GM, Streiner DL, Boyle MH, Cunningham CE, Lach L, Verhey LH, Fayed N, Chen K, Rosenbaum PL, Connolly M, Bello-Espinosa LE, Rafay MF, Appendino JP, Shevell M, Carmant L. Outcomes trajectories in children with epilepsy: hypotheses and methodology of a Canadian longitudinal observational study. Pediatr Neurol 2014; 50:38-48. [PMID: 24370172 DOI: 10.1016/j.pediatrneurol.2013.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The impact of childhood epilepsy can only be appreciated by understanding that epilepsy comprises a set of complex neurobehavioral conditions with significant social consequences, and not simply disorders of recurrent seizures. Our objective is to describe the hypotheses and methodology behind a large prospective longitudinal study that is based on a conceptual framework for understanding health outcomes. The study will quantify the specific influences--direct, mediating or moderating--that various epilepsy, comorbid, child, and family variables exert on health over the early life course. METHODS The target population is 8- to 14-year-old children with epilepsy and their caregivers from across Canada. Children, caregivers, and health professionals are completing 17 measures at five visits over a 28-month period. We have selected measures based on content, the source of the items, psychometric properties, and provisions for child self-report. Our cross-sectional and longitudinal design includes a relational model for structural equation modeling of specific biomedical and psychosocial variables with hierarchical direction of influence. To measure change over time, we will use hierarchical linear modeling. SIGNIFICANCE This article reports the framework for interpreting future data. We believe that it will help researchers consider their methodology and encourage them to plan and execute longitudinal studies. Furthermore, the article will help clinical readers identify what to look for when evaluating outcomes research. It is our belief that the next generation of research to understand life-course effect in the lives of children and youth with chronic conditions and their families must occur over real time.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michael H Boyle
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Charles E Cunningham
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lucyna Lach
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Leonard H Verhey
- Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nora Fayed
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen Chen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Peter L Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Ferro MA, Landgraf JM, Speechley KN. Factor structure of the Child Health Questionnaire Parent Form-50 and predictors of health-related quality of life in children with epilepsy. Qual Life Res 2013; 22:2201-11. [PMID: 23334980 DOI: 10.1007/s11136-013-0351-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE The present study investigated the higher-order summary factor structure of the Child Health Questionnaire Parent Form-50 (CHQ) in a sample of children with new-onset epilepsy. The secondary aim was to identify risk factors predicting health-related quality of life (HRQL) 24 months post-diagnosis. METHODS Data came from the Health-related Quality of Life in Children with Epilepsy Study (HERQULES, N = 374), a multi-site study documenting HRQL among children with epilepsy from diagnosis through 24 months. Confirmatory factor analysis was used to determine goodness of fit between the original structure of the CHQ and HERQULES data. Multiple regression was used to identify risk factors at diagnosis for HRQL at 24 months. RESULTS The models demonstrated good fit: baseline: CFI = 0.945; TLI = 0.941; WRMR = 1.461; RMSEA = 0.058; 24 months: CFI = 0.957; TLI = 0.954; WRMR = 1.393; RMSEA = 0.055. Factor loadings were high and no cross-loadings observed (first order: λ = 0.27-0.99, 0.24-0.98; second order: λ = 0.69-0.86, 0.54-0.92; p < 0.001 for all). Controlling for HRQL at diagnosis, predictors for better 24-month HRQL were as follows: physical health: fewer cognitive problems (p = 0.023) and parents with fewer depressive symptoms (p = 0.049); psychosocial health: older parent age (p = 0.043), fewer behavior problems (p = 0.004), and families with better functioning (p = 0.008) and fewer demands (p = 0.009). CONCLUSIONS The CHQ higher-order summary factor structure was replicated in a sample of children with new-onset epilepsy, and child and family risk factors at diagnosis were found to predict HRQL 24 months post-diagnosis. These findings suggest it is possible to identify at-risk children early in the illness process and provide impetus for adopting family-centered care practices.
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Affiliation(s)
- Mark A Ferro
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Chedoke Site, Central Building, Room 310, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada,
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Ronen GM, Rosenbaum PL. Health outcomes measurement: concepts, guidelines and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:35-41. [PMID: 23622149 DOI: 10.1016/b978-0-444-52891-9.00004-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this chapter we argue that modern thinking about chronic neurological and developmental conditions requires that we recognize all aspects of functioning and quality of life in addition to the biomedical dimensions of these disorders. We find the International Classification of Functioning, Disability, and Health (ICF) a useful framework by which to think about and understand the many dimensions of health; and we appreciate its heuristic value as a stimulus to consider a range of outcomes of these individuals. Quality of Life (QOL) and Health-Related Quality of Life (HRQL) cover the additional perceived dimensions that are so important to patients' personal valuations, aspirations, and satisfaction about health throughout their lifespan, of which we see QOL being the broader construct. In order to measure outcomes at either the individual clinical or research level it is essential to ask clear and specific questions as a prelude to selecting measures that are appropriate in terms of both their content and their measurement properties. We provide some brief guidelines that we hope will be helpful to readers who wish to expand their activities in measuring clinical outcomes.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Canada.
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Manor L, Streiner DL, Yam WKL, Rosenbaum PL, Verhey LH, Lach L, Ronen GM. Age-related variables in childhood epilepsy: how do they relate to each other and to quality of life? Epilepsy Behav 2013; 26:71-4. [PMID: 23220463 DOI: 10.1016/j.yebeh.2012.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 11/30/2022]
Abstract
How do age of onset and duration of epilepsy correlate with each other and with patient-reported outcomes? To address this question, we explored whether age of onset, duration, and proportion of life with epilepsy are either similar or relatively independent variables that can be used as markers on how children experience the complexity of epilepsy and adjustment. Three hundred ninety-one Canadian and 266 Hong Kong youth with epilepsy completed the childhood epilepsy-specific quality of life (QOL) measure (CHEQOL-25). Each cohort was separately stratified by tertiles for age of onset, life proportion with epilepsy, and duration of epilepsy. Pearson's r was used for correlation analysis. The epilepsy age-related variables correlated strongly with each other among children with epilepsy onset ≤4 years (r = 0.53-0.66). The correlation between these variables was weaker with an onset ≥9 years (r =0.22-0.35). Correlation with QOL was clinically non-significant. These variables appear to measure the same phenomenon only in children with early epilepsy onset (<4 years) and explain little variance in QOL.
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Soria C, Escolano S, El Sabbagh S, Chmura S, Bulteau C, Chiron C, Dellatolas G. Behavioral problems, cognitive difficulties and quality of life in children with epilepsy: An analysis of parental concerns. Child Neuropsychol 2012; 18:209-27. [DOI: 10.1080/09297049.2011.602012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Júnior JSDC, de Almeida AAC, Tomé ADR, Citó AMDGL, Saffi J, de Freitas RM. Evaluation of possible antioxidant and anticonvulsant effects of the ethyl acetate fraction from Platonia insignis Mart. (Bacuri) on epilepsy models. Epilepsy Behav 2011; 22:678-84. [PMID: 22056341 DOI: 10.1016/j.yebeh.2011.09.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 09/16/2011] [Accepted: 09/16/2011] [Indexed: 11/29/2022]
Abstract
The aim of present study was to examine the effects of the ethyl acetate fraction (EAF) from Platonia insignis on lipid peroxidation level, nitrite formation, and superoxide dismutase and catalase activities in rat striatum prior to pilocarpine-induced seizures as well as to explore its anticonvulsant activity in adult rats prior to pentylenetetrazole (PTZ)- and picrotoxin (PIC)-induced seizures. Wistar rats were treated with vehicle, atropine (25mg/kg), EAF (0.1, 1, and 10mg/kg), pilocarpine (400mg/kg, P400 group), PTZ (60 mg/kg, PTZ group), PIC (8 mg/kg, PIC group), atropine+P400, EAF+P400, EAF+PTZ, or EAF+PIC. Significant decreases in number of crossings and rearings were observed in the P400 group. The EAF 10+P400 group also had significant increases in these parameters. In addition, in rats treated with P400, there were significant increases in lipid peroxidation and nitrite levels; however, there were no alterations in SOD and catalase activities. In the EAF 10+P400 group, lipid peroxidation and nitrite levels significantly decreased and SOD and catalase activities significantly increased after pilocarpine-induced seizures. Additionally, effects of the EAF were evaluated in PTZ and PIC models. EAF did not increase the latency to development of convulsions induced with PTZ and PIC at the doses tested. Our findings strongly support the hypothesis that EAF does not have anticonvulsant activity in the different models of epilepsy studied. Our results indicate that in the in vivo model of pilocarpine-induced seizures, EAF has antioxidant activity, but not anticonvulsant properties at the doses tested.
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Affiliation(s)
- Joaquim Soares da Costa Júnior
- Laboratory of Genetic Toxicology, Postgraduate Program in Genetic and Applied Toxicology, Lutheran University of Brazil, Canoas, RS, Brazil
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Abstract
This paper first summarizes the main findings of clinical studies conducted over the past two and a half decades on psychopathology (i.e., psychiatric diagnoses, behavior and emotional problems) in children with new onset and chronic epilepsy both with and without intellectual disability who are treated medically and surgically. Although impaired social relationships are core features of the psychiatric disorders found in pediatric epilepsy, few studies have examined social competence (i.e., social behavior, social adjustment, and social cognition) in these children. There also is a dearth of treatment studies on the frequent psychiatric comorbidities of pediatric epilepsy, attention deficit hyperactivity disorder, anxiety disorders, and depression. Drs. Hamiwka and Jones then describe their current and planned studies on social competence and cognitive behavioral treatment of anxiety disorders, respectively, in these children and how they might mitigate the poor long-term psychiatric and social outcome of pediatric epilepsy.
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Affiliation(s)
- Lorie Hamiwka
- Division of Child Neurology, Ohio State University College of Medicine, Columbus, OH, USA
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Stevanovic D, Jancic J, Lakic A. The impact of depression and anxiety disorder symptoms on the health-related quality of life of children and adolescents with epilepsy. Epilepsia 2011; 52:e75-8. [PMID: 21692790 DOI: 10.1111/j.1528-1167.2011.03133.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dejan Stevanovic
- Department of Psychiatry, General Hospital Sombor, Sombor, Serbia.
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Brunklaus A, Dorris L, Zuberi SM. Comorbidities and predictors of health-related quality of life in Dravet syndrome. Epilepsia 2011; 52:1476-82. [DOI: 10.1111/j.1528-1167.2011.03129.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ronen GM, Fayed N, Rosenbaum PL. Outcomes in pediatric neurology: a review of conceptual issues and recommendationsThe 2010 Ronnie Mac Keith Lecture. Dev Med Child Neurol 2011; 53:305-12. [PMID: 21401584 DOI: 10.1111/j.1469-8749.2011.03919.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper discusses how to evaluate whether, and in what ways, treatments affect the lives of children with neurological conditions and their families. We argue that professionals should incorporate perspectives from patients and families to help them make decisions about what 'outcomes' are important, and we discuss how those outcomes might be assessed. A case vignette illustrates the differences and complementarity between the perspectives of clinicians and those of children and their parents. We recommend methods for expanding the range of relevant health outcomes in child neurology to include those that reflect the ways patients and families view their conditions and our interventions. We explore the added value of a 'non-categorical' approach to the choice of outcomes. The International Classification of Functioning, Disability and Health is a useful biopsychosocial framework to 'rule in' relevant aspects of child and family issues to create a dynamic system of possible influences on outcomes. We examine the meaning of 'health', 'health-related quality of life', and 'quality of life' as related but conceptually distinct outcomes. Specific issues are discussed about the construction, validation, and appraisal of outcome measures, as well as practical recommendations on how to select outcome measures in the clinical setting and research.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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