Can behavioral strategies increase physical activity and influence depressive symptoms and quality of life among children with epilepsy? Results of a randomized controlled trial

Accelerometer and Survey Assessed Physical Activity in Children With Epilepsy: A Case-Controlled Study

PURPOSE

Anecdotal evidence suggests that children with epilepsy (CWE) are limited in the frequency of their daily physical activity (PA). However, there is limited research utilizing device-based measures of PA. We compared levels of PA and sedentary behavior in CWE (11-15 y) and age- and gender-matched healthy controls.

METHOD

Participants (n = 60 CWE [25 males, 35 females] and n = 49 controls [25 males, 24 females]) wore a Actigraph accelerometer (GT3X or GT3X+) for 7 consecutive days during waking hours and self-reported their PA and sedentary behaviors. CWE were compared with control children on time spent in different intensities of PA and on self-reported PA and sedentary behavior. Factors associated with PA were analyzed using linear regression.

RESULTS

CWE spent less time in accelerometer assessed light (189.15 vs 215.01 min/d, P < .05) and vigorous PA (35.14 vs 44.28 min/d, P < .05) on weekdays compared with controls. There were no significant differences between CWE and control participants in accelerometer assessed time spent sedentary or time spent in PA on weekends. Among CWE, older children engaged in more reported sedentary behavior and younger children spent more time in most domains of PA (P < .05). Furthermore, CWE reported less PA than controls (P = .006). Sixteen percent of controls met World Health Organization PA guidelines compared with 10% of CWE. There was a positive relationship between accelerometer assessed PA and quality of life for CWE.

CONCLUSION

CWE spent less time in light and moderate to vigorous PA on weekdays. Further research is needed to understand reasons for these differences.

Consensus-based recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy: A report from the Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy

The Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy (ILAE) aimed to develop recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy. The Task Force conducted a systematic review and identified two studies that assessed the accuracy of four screening measures for depression and anxiety symptoms compared with a psychiatric interview. Nine studies met the eligibility criteria for treatment of anxiety and depressive disorders or symptoms. The risk of bias and certainty of evidence were assessed. The evidence generated by this review followed by consensus where evidence was missing generated 47 recommendations. Those with a high level of agreement (≥80%) are summarized. Diagnosis: (1) Universal screening for anxiety and depression is recommended. Closer surveillance is recommended for children after 12 years, at higher risk (e.g., suicide-related behavior), with subthreshold symptoms, and experiencing seizure worsening or therapeutic modifications. (2) Multiple sources of ascertainment and a formal screening are recommended. Clinical interviews are recommended whenever possible. The healthcare provider must always explain that symptom recognition is essential to optimize treatment outcomes and reduce morbidity. (3) Questioning about the relationship between symptoms of anxiety or depression with seizure worsening/control and behavioral adverse effects of antiseizure medications is recommended. Treatment: (1) An individualized treatment plan is recommended. (2) For mild depression, active monitoring must be considered. (3) Referral to a mental health care provider must be considered for moderate to severe depression and anxiety. (4) Clinical care pathways must be developed. (5) Psychosocial interventions must be tailored and age-appropriate. (6) Healthcare providers must monitor children with epilepsy who are prescribed antidepressants, considering symptoms and functioning that may not improve simultaneously. (7) Caregiver education is essential to ensure treatment adherence. (8) A shared-care model involving all healthcare providers is recommended for children and adolescents with epilepsy and mental health disorders. We identified clinical decisions in the management of depression and anxiety that lack solid evidence and provide consensus-based guidance to address the care of children and adolescents with epilepsy.

Trends and disparities in the prevalence of physical activity among US adults with epilepsy, 2010-2022

BACKGROUND

Physical activity may be associated with health benefits for people with epilepsy. It remains unclear how the prevalence of physical activity has changed at a national level over the years and whether this prevalence varies between subgroups.

METHODS

The National Health and Interview Survey, which was conducted from 2010 to 2017 and again in 2022, was used for our nationally representative study. This study explored the trends and disparities in meeting physical activity guidelines among US individuals with epilepsy and non-epilepsy adults.

RESULTS

The prevalence of adults with epilepsy meeting physical activity guidelines was consistently lower and remained unchanged compared to those without epilepsy. Among the population with epilepsy, the prevalence of aerobic physical activity was 38.1 % (95 % CI, 32.6 %-43.5 %) in 2010 and 39.0 % (95 % CI, 33.4 %-44.7 %) in 2017 (P for trend = 0.84), and remained unchanged in 2022 (39.1 %). For muscle-strength training, the prevalence was 17.5 % (95 % CI, 13.3 %-21.7 %) in 2010 and 18.8 % (95 % CI, 14.8 %-22.8 %) in 2017 (P for trend = 0.82). The prevalence for both activities combined was 12.4 % (95 % CI, 8.7 %-16.2 %) in 2010 and 16.6 % (95 % CI, 12.8 %-20.5 %) in 2017 (P for trend = 0.26). The prevalence of aerobic physical activity varied by educational attainment, body mass index, comorbid conditions, alcohol-drinking status, and epilepsy status.

CONCLUSION

This study suggests that the adherence rate to meeting physical activity guidelines among US adults with epilepsy was at a low level and had not improved over time. This finding highlights the need for additional nationwide efforts to promote physical activity in the US population with epilepsy.

Effects of physical activity on cognition and psychosocial functioning in pediatric epilepsy: A systematic review

Pediatric patients with epilepsy often have psychosocial and cognitive difficulties. Physical activity has emerged as a lifestyle modification that may reduce seizure burden, enhance brain plasticity, and improve cognitive and psychosocial comorbidities. We systematically reviewed published studies examining the effect of physical activity on cognitive and psychosocial function in children and adolescents with epilepsy. Studies were identified with PubMed and Emory Library databases. Eleven studies met inclusion criteria. Six of 10 studies related to psychosocial outcomes showed benefits of physical activity in children and adolescents with epilepsy, including improvements in internalizing symptoms, relationships, self-esteem, and psychological well-being, but four of the 10 studies showed no psychosocial benefits. Of the six studies evaluating cognitive outcomes, all six indicated that physical activity was associated with cognitive improvements in pediatric epilepsy, including areas of attention, processing speed, executive function, and memory. Our review was limited by the paucity of published studies on this topic, and the use of different measurement tools limited our ability to make direct comparisons between studies. Additional studies that compare pediatric epilepsy populations to non-epilepsy control groups are needed to better understand how physical activity affects seizure control and epilepsy-related comorbidities.

"One size does not fit all" - Barriers to and facilitators of physical activity in adolescents with epilepsy

OBJECTIVE

To explore the barriers to physical activity and to identify the support needed to facilitate physical activity in adolescents with epilepsy (AWE).

METHODS

AWE (aged 11-16 years) and their caregivers completed survey-based open questions regarding perceived barriers to, and facilitators of physical activity in young people with epilepsy. The responses were analysed using Thematic Analysis.

RESULTS

Themes concerning barriers to physical activity included concerns about seizure safety, general anxiety and anxiety related to seizures, stigma/negative attitudes associated with having epilepsy, tiredness, and perceived lack of physical competence. Themes regarding the support needed to facilitate physical activity included better education amongst staff/coaches about epilepsy (e.g., seizure management/prevention, associated fatigue/tiredness), improvements in societal attitudes towards epilepsy, flexibility/tailoring of activities to the child's needs (e.g., need for breaks), and peer support for young people with epilepsy to encourage engagement in physical activity.

CONCLUSIONS

There is a perception among AWE and caregivers, that significant barriers exist with regard to engaging in physical activity for young people with epilepsy. Barriers are related to concerns about seizure management but also wider safety and social issues. A number of facilitators were identified to promote physical activity engagement in AWE, including education for staff and caregivers, peer support, and tailoring activities to the adolescent's needs. There is a need to develop interventions to reduce barriers to physical activity in young people with epilepsy.

Lifestyle Behavioral Interventions and Health-Related Outcomes Among People with Epilepsy: A Review of Randomized Controlled Trials

OBJECTIVE

To gather and assess current literature on the prevalence and efficacy of lifestyle behavioral interventions (sleep, nutrition, physical activity) for health outcomes, including QOL, psychological well-being, behavioral changes, and seizure frequency, among PWE.

DATA SOURCE

A review was conducted of English-language articles identified from PubMed, Scopus, and Embase between January 2013 to January 2023.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria were randomized controlled trials (RCT) with human subjects diagnosed with epilepsy who participated in a lifestyle behavioral intervention.

DATA EXTRACTION

Two researchers independently completed the title, abstract, and full-text reviews. Information extracted includes study population, duration, type of intervention, findings, and outcomes.

DATA SYNTHESIS

Data was narratively synthesized to show level of evidence and degree of consistency in findings. Results: 4001 studies identified, 66 full texts reviewed, and 24 included. A majority (n = 16) of studies utilized diet specific RCTs, and some focused on physical activity (n = 7) and sleep (n = 1). Diet-specific RCTs (eg, ketogenic, Modified Atkins) reported reduced seizure frequency with adverse effects, such as gastrointestinal complications. Physical activity-based interventions found that maintained levels of exercise improved QOL and psychological well-being. However, physical activity and diet-based interventions did not have lasting effects after study conclusion. Only the behavioral sleep intervention reported that sleep quality improved significantly and was maintained post-intervention.

CONCLUSION

Future research is needed to establish the relationship between lifestyle behavioral interventions on QOL and other health outcomes (eg, seizure frequency).

Effects of exercise on sleep in patients with epilepsy: A systematic review

Exercise interventions in epilepsy have been shown to improve seizure frequency, physical capacity, quality of life, mood, and cognitive functioning. However, the effectiveness of exercise in improving sleep in epilepsy is less clear. The purpose of this report is to identify the published literature regarding exercise interventions in people with epilepsy to determine 1) what proportion of published clinical trials assess sleep as an outcome, and 2) what benefits of exercise interventions on sleep have been observed. We searched the PubMed, PsycINFO, and SCOPUS electronic databases using the search terms "epilepsy AND [exercise OR physical activity]" and identified 23 articles reporting on 18 unique clinical trials. Nine studies were conducted in adults, five in children, and four in adults and children with active seizures, controlled seizures, or both. Exercise modalities included aerobic exercise, strength training, walking, and yoga, among others, and some also included educational and motivational components. Exercise effects on sleep were tested in four studies, two of which only included indirect measures of sleep- and rest-related fatigue, with mixed results. Of the two reports assessing sleep directly, one reported marginal non-significant improvements in subjective sleep quality and no improvements in objective sleep quality in children after twelve weeks of walking, and the other reported no benefits in subjective sleep quality after twelve weeks of combined aerobic, strength, and flexibility training in adults. Given the health benefits of sleep and detrimental effects of sleep deprivation in epilepsy, epilepsy researchers need to assess the effects of exercise interventions on sleep.

A systematic review of psychosocial interventions for children and young people with epilepsy

BACKGROUND

Epilepsy is a lifelong neurological disorder that has a profound impact on the lives of millions of children and young people throughout the world, and is linked with mental ill-health and a poorer quality of life. Psychosocial interventions have showed promise for children and young people with epilepsy (CYPE), however there is an absence of large-scale RCT's that would add robustness to the evidence base. The present systematic review provides an update and extension of findings from an earlier review by Corrigan et al. to assess the state of the literature in 2023.

METHODS

The present systematic review carried out a search of six electronic databases. Forward and backward chaining was carried out on review articles as well as the studies returned through the search to source additional studies. In total, ten articles were included in this review and appraised for quality using the Crowe Critical Appraisal Tool (CCAT).

RESULTS

Forty percent (4/10) of the included studies were rated as high quality according to the CCAT, which represents a significant proportional increase since Corrigan et al.'s review. A meta-analysis of results was not possible due to significant methodological heterogeneity, and the variability of outcome measures, however effect sizes were reported or calculated for the majority of studies (7/10), which facilitated comparison. Despite the issues of relatively small samples, there are promising findings with regard to psychosocial interventions increasing epilepsy knowledge, coping strategies, self-efficacy, and quality of life markers.

CONCLUSIONS

There is a growing evidence base supporting the efficacy of psychosocial interventions for children and young people with epilepsy. This evidence base is also increasing in quality. Particular components of treatment that prove to be effective include psychoeducation, components based on cognitive behavioural therapy principles, as well as mindfulness techniques. This aligns with the evidence-based recommendations for adult populations. Intervention goals centre around improving quality of life, reducing symptom distress, and increasing knowledge and skills. The instruments used to measure these outcomes are predominantly standardised, however remain heterogeneous between studies which impacts the overall robustness of the evidence base.

Physical exercise for children and adolescents with epilepsy: What have we learned?

PURPOSE

Although clinical and experimental studies have extensively evidenced the positive effect of physical exercise on epilepsy, these benefits in children and adolescents with epilepsy have been less investigated. We explored the published literature evaluating the impact of long-term exercise programmes on seizure frequency and quality of life in children/adolescents with epilepsy.

METHODS

A scoping review of the literature was performed in accordance with PRISMA guidance with suitable search terms. A comprehensive search of PubMed, PEDro, Web of Science, Scopus, Google Scholar and SPORTDiscus with Full Text (EBSCO) was performed from March to April 2023. A methodological quality assessment was completed for the included studies. The included studies were analysed qualitatively to identify key themes and provide a narrative description of the evidence by two reviewers.

RESULTS

Of 1,316 papers screened, 13 studies were selected for full reading. Only six studies evaluated the seizure frequency and quality of life in children and adolescents with epilepsy after a long-term exercise programme. Two studies observed positive findings in seizure frequency and three in quality of life. No study was classified with strong methodological quality. Three studies presented good quality 78-61%, one study presented adequate quality 57%, and two studies presented poor methodological quality (39% and 43%).

CONCLUSIONS

Our review highlights a limited number of investigations evaluating the long-term effect of exercise in children and adolescents with epilepsy. Longitudinal investigations with good methodological quality may be performed to examine the effectiveness of exercise in this population.

Associations between 24-hour movement guideline adherence and mental health disorders among young people with active and inactive epilepsy

OBJECTIVE

(1) Examine 24-hour movement guideline adherence among young people with active and inactive epilepsy compared to population norms. (2) Investigate associations between 24-hour movement guideline adherence and mental health disorders among these subpopulations.

METHODS

Cross-sectional data from the 2016 to 2019 cycles of the National Survey of Children's Health were used. Parental/caregiver reports of movement behaviors (physical activity, screen time, sleep, and sport participation) were used to determine adherence to the 24-hour movement guidelines and associations with mental health disorders for young people with active (n = 663) and inactive epilepsy (n = 526) as well as population norms (n = 49,067) between 6 and 17 years old. Multivariate logistic regression analyses were conducted.

RESULTS

Young people with active epilepsy were less likely to meet the 24-hour movement guidelines than population norms, largely driven by below average levels of physical activity guideline adherence. Sport participation was lower among both young people with active and inactive epilepsy; seizure severity and health-related limitations played an influential role. Beneficial associations were generally observed between 24-hour movement guideline adherence and mental health disorders, although for young people with active and inactive epilepsy, there was considerable variability among these relationships.

CONCLUSIONS

Further dissemination of the International League Against Epilepsy's Task Force on Sports and Epilepsy report can help improve promotion of physical activity and sport participation among young people with active and inactive epilepsy. The relationship between 24-hour movement guideline adherence and mental health disorders is complex among young people with epilepsy and longitudinal research is needed to determine causal links.

Comparison of physical fitness, activity, and quality of life of the children with epilepsy and their healthy peers

OBJECTIVE

To identify physical fitness and activity levels, and health-related quality of life of children with epilepsy in Turkey and compare the results with their healthy peers.

METHODS

The study included 21 children with epilepsy (with no seizures and not taking anti-epileptic drugs for at least a year) and 20 healthy peers. The FitnessGram Physical Fitness Test Battery was used to assess physical fitness, the 6-Minute Walk Test to assess physical performance, the Pediatric Quality of Life Inventory 4.0 (PedsQL) to assess the quality of life, and a pedometer was used to assess the physical activity of the children.

RESULTS

The physical fitness assessments including the trunk-lift test and flamingo balance test results were significantly lower in the children with epilepsy (p < 0.05). There was no significant difference between the groups in terms of BMI, the cadence-based curl-up test, the push-up test and the back saver sit/reach test (p > 0.05). Physical activity, physical performance, and quality of life results were significantly lower in children with epilepsy (p < 0.05).

CONCLUSION

The presence of epilepsy may negatively affect many aspects of physical fitness, physical activity, and quality of life in childhood. The children with epilepsy adopted a more sedentary lifestyle than their healthy peers. Quality of life outcomes reveal that epilepsy has negative physical and psychosocial effects on children. These results support the necessity of raising awareness in both health professionals and families to encourage their children to be more active.

The Benefits of Physical Activity in Children and Adolescents with Epilepsy: A Systematic Review

The aim of this study was to review the literature about the effect of physical activity intervention in children and adolescents with epilepsy. Articles were searched in the central electronic databases of MEDLINE, Embase, PsycAriticles, and CINAHL for the following keywords: “epilepsy,” “seizure,” “physical activity,” “physical exercise,” “exercise therapy,” “sport,” using the Boolean operator “AND” and “OR.” The quality of the selected articles was evaluated by the Physiotherapy Evidence Database scale. Out of the 22 articles selected, 18 did not involve intervention or did not have pre- and postresults and therefore were excluded from the study. The remaining four were studies from Canada and Korea which comprised two long-period interventions and were included in the analysis. Both programs demonstrated a positive effect of physical activity on variables related to psychological well-being and cognitive function. All the four articles demonstrated a lower score of quality. In conclusion, reviewed studies suggest that physical exercise program induces some benefits in children and adolescents with epilepsy. However, the noncontrolled trials and the varied analyses (quantitative vs. qualitative) make it difficult to establish a consensus about benefits of physical activity in epilepsy.

Psychological treatments for people with epilepsy

BACKGROUND

Given the significant impact epilepsy may have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is increasing clinical interest in evidence-based psychological treatments, aimed at enhancing psychological and seizure-related outcomes for this group. This is an updated version of the original Cochrane Review published in Issue 10, 2017.

OBJECTIVES

To assess the impact of psychological treatments for people with epilepsy on HRQOL outcomes.

SEARCH METHODS

For this update, we searched the following databases on 12 August 2019, without language restrictions: Cochrane Register of Studies (CRS Web), which includes randomized or quasi-randomized controlled trials from the Specialized Registers of Cochrane Review Groups including Epilepsy, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to 09 August 2019), and PsycINFO (EBSCOhost, 1887 onwards), and from PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP). We screened the references from included studies and relevant reviews, and contacted researchers in the field for unpublished studies.

SELECTION CRITERIA

We considered randomized controlled trials (RCTs) and quasi-RCTs for this review. HRQOL was the main outcome. For the operational definition of 'psychological treatments', we included a broad range of skills-based psychological treatments and education-only interventions designed to improve HRQOL, seizure frequency and severity, as well as psychiatric and behavioral health comorbidities for adults and children with epilepsy. These psychological treatments were compared to treatment as usual (TAU), an active control group (such as social support group), or antidepressant pharmacotherapy.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included 36 completed RCTs, with a total of 3526 participants. Of these studies, 27 investigated skills-based psychological interventions. The remaining nine studies were education-only interventions. Six studies investigated interventions for children and adolescents, three studies investigated interventions for adolescents and adults, and the remaining studies investigated interventions for adults. Based on satisfactory clinical and methodological homogeneity, we pooled data from 11 studies (643 participants) that used the Quality of Life in Epilepsy-31 (QOLIE-31) or other QOLIE inventories (such as QOLIE-89 or QOLIE-31-P) convertible to QOLIE-31. We found significant mean changes for the QOLIE-31 total score and six subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication effects, and cognitive functioning). The mean changes in the QOLIE-31 total score (mean improvement of 5.23 points, 95% CI 3.02 to 7.44; P < 0.001), and the overall QoL score (mean improvement of 5.95 points, 95% CI 3.05 to 8.85; P < 0.001) exceeded the threshold of minimally important change (MIC: total score: 4.73 points; QoL score: 5.22 points), indicating a clinically meaningful postintervention improvement in HRQOL. We downgraded the certainty of the evidence provided by the meta-analysis due to serious risks of bias in some of the included studies. Consequently, these results provided moderate-certainty evidence that psychological treatments for adults with epilepsy may enhance overall HRQOL.

AUTHORS' CONCLUSIONS

Implications for practice: Skills-based psychological interventions improve HRQOL in adults and adolescents with epilepsy. Adjunctive use of skills-based psychological treatments for adults and adolescents with epilepsy may provide additional benefits in HRQOL when these are incorporated into patient-centered management. We judge the evidence to be of moderate certainty.

IMPLICATIONS FOR RESEARCH

Investigators should strictly adhere to the CONSORT guidelines to improve the quality of reporting on their interventions. A thorough description of intervention protocols is necessary to ensure reproducibility. When examining the effectiveness of psychological treatments for people with epilepsy, the use of standardized HRQOL inventories, such as the Quality of Life in Epilepsy Inventories (QOLIE-31, QOLIE-31-P, and QOLIE-89) would increase comparability. Unfortunately, there is a critical gap in pediatric RCTs and RCTs including people with epilepsy and intellectual disabilities. Finally, in order to increase the overall quality of RCT study designs, adequate randomization with allocation concealment and blinded outcome assessment should be pursued. As attrition is often high in research that requires active participation, an intention-to-treat analysis should be carried out. Treatment fidelity and treatment competence should also be assessed. These important dimensions, which are related to 'Risk of bias' assessment, should always be reported.

Drivers for the comorbidity of type 2 diabetes mellitus and epilepsy: A scoping review

Epilepsy, a common neurologic condition, is associated with a greater prevalence of type 2 diabetes mellitus (T2DM). We examined potential drivers for the comorbidity of epilepsy and T2DM in an attempt to elucidate possible biological mechanisms underlying the development of processes in individuals. We searched PubMed and Medline up to December 2019. Our search yielded 3361 articles, of which 82 were included in the scoping review. We reviewed articles focusing on the association of epilepsy and T2DM, drivers, and biological mechanisms. We found that epilepsy is associated with obesity and obesity is associated with T2DM. Treatment with valproate (either sodium or acid) is associated with weight increase and hyperinsulinemia, while topiramate causes weight loss. People with epilepsy are less likely to exercise, which is protective against obesity. Mitochondrial dysfunction and adiponectin deficiency are common to epilepsy and T2DM. One possible mechanism for the comorbidity is mitochondrial dysfunction and adiponectin deficiency, which promotes epilepsy, obesity, and T2DM. Another possible mechanism is that people with epilepsy are more likely to be obese because of the lack of exercise and the effects of some antiseizure medications (ASMs), which makes them susceptible to T2DM because of the development of mitochondrial dysfunction and adiponectin deficiency. A third mechanism is that people with epilepsy have greater mitochondrial dysfunction and lower adiponectin levels than people without epilepsy at baseline, which may exacerbate after treatment with ASMs. Future research involving a combined genetic and molecular pathway approach will likely yield valuable insight regarding the comorbidity of epilepsy and T2DM.

Physically active children with epilepsy have good objective sleep duration and efficiency despite subjective reports of fatigue and sleep problems

OBJECTIVE

The aim of this study was to longitudinally characterize in children with epilepsy the objective and subjective sleep quality and the relationship between increased physical activity and sleep as well as measures of psychosocial well-being.

METHODS

Baseline physical activity and sleep were established in children with epilepsy over four weeks, prior to a 12-week exercise intervention (weekly meeting with exercise counselor). Participants continuously wore a wrist pedometer (Fitbit Flex®) to capture daily number of steps, sleep efficiency, and total sleep time. The Early Childhood Epilepsy Severity Scale (E-Chess) assessed baseline epilepsy severity. Subjective sleep quality (Children's Sleep Habits Questionnaire, CSHQ), quality of life (KIDSCREEN-27; Pediatric Quality of Life Inventory, PedsQL™, 4.0 Core), fatigue (PedsQL™ Multidimensional Fatigue Scale), depression (Children's Depression Inventory-Short), and anxiety (Multidimensional Anxiety Scale for Children) were assessed pre- and post-interventions.

RESULTS

Our cohort of 22 children with epilepsy aged 8-14 years was similarly active to peers (11,271 ± 3189 mean steps per day) and displayed normal sleeping patterns (mean sleep efficiency: 87.4% ± 3.08 and mean total sleep time: 521 ± 30.4). Epilepsy severity assessed by E-Chess was low to moderate (median baseline E-Chess score of 6, interquartile range: 5-7). Study outcomes did not change with the intervention. Older children and those with lower baseline activity were more likely to increase their activity during the intervention. Changes in physical activity were not associated with changes in sleep outcomes when accounting for age, sex, and baseline E-Chess score. Subjective sleep quality marginally improved with the intervention (CSHQ total score: 44.5 ± 5.8 at baseline and 41.6 ± 7.2 at the end of study, p = 0.05). Quality of life, fatigue, depression, and anxiety did not change with the intervention (p = 0.55, 0.60, 0.12, and 0.69, respectively).

SIGNIFICANCE

Children with epilepsy who are as active as peers without epilepsy have good objective measures of sleep despite self-reported fatigue and parent-reported sleep problems. The physical activity of initially less active and older children with epilepsy may benefit from an exercise counseling intervention.