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Wissel BD, Greiner HM, Glauser TA, Pestian JP, Ficker DM, Cavitt JL, Estofan L, Holland-Bouley KD, Mangano FT, Szczesniak RD, Dexheimer JW. Early Identification of Candidates for Epilepsy Surgery: A Multicenter, Machine Learning, Prospective Validation Study. Neurology 2024; 102:e208048. [PMID: 38315952 PMCID: PMC10890832 DOI: 10.1212/wnl.0000000000208048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/13/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy surgery is often delayed. We previously developed machine learning (ML) models to identify candidates for resective epilepsy surgery earlier in the disease course. In this study, we report the prospective validation. METHODS In this multicenter, prospective, longitudinal cohort study, random forest models were validated at a pediatric epilepsy center consisting of 2 hospitals and 14 outpatient neurology clinic sites and an adult epilepsy center with 2 hospitals and 27 outpatient neurology clinic sites. The models used neurology visit notes, EEG and MRI reports, visit patterns, hospitalizations, and medication, laboratory, and procedure orders to identify candidates for surgery. The models were trained on historical data up to May 10, 2019. Patients with an ICD-10 diagnosis of epilepsy who visited from May 11, 2019, to May 10, 2020, were screened by the algorithm and assigned surgical candidacy scores. The primary outcome was area under the curve (AUC), which was calculated by comparing scores from patients who underwent epilepsy surgery before November 10, 2020, against scores from nonsurgical patients. Nonsurgical patients' charts were reviewed to determine whether patients with high scores were more likely to be missed surgical candidates. Delay to surgery was defined as the time between the first visit that a surgical candidate was identified by the algorithm and the date of the surgery. RESULTS A total of 5,285 pediatric and 5,782 adult patients were included to train the ML algorithms. During the study period, 41 children and 23 adults underwent resective epilepsy surgery. In the pediatric cohort, AUC was 0.91 (95% CI 0.87-0.94), positive predictive value (PPV) was 0.08 (0.05-0.10), and negative predictive value (NPV) was 1.00 (0.99-1.00). In the adult cohort, AUC was 0.91 (0.86-0.97), PPV was 0.07 (0.04-0.11), and NPV was 1.00 (0.99-1.00). The models first identified patients at a median of 2.1 years (interquartile range [IQR]: 1.2-4.9 years, maximum: 11.1 years) before their surgery and 1.3 years (IQR: 0.3-4.0 years, maximum: 10.1 years) before their presurgical evaluations. DISCUSSION ML algorithms can identify surgical candidates earlier in the disease course. Even at specialized epilepsy centers, there is room to shorten the time to surgery. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that a machine learning algorithm can accurately distinguish patients with epilepsy who require resective surgery from those who do not.
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Affiliation(s)
- Benjamin D Wissel
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - Hansel M Greiner
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - Tracy A Glauser
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - John P Pestian
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - David M Ficker
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - Jennifer L Cavitt
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - Leonel Estofan
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - Katherine D Holland-Bouley
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - Francesco T Mangano
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - Rhonda D Szczesniak
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
| | - Judith W Dexheimer
- From the Division of Biomedical Informatics (B.D.W., J.P.P., J.W.D.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.M.G., T.A.G., J.P.P., K.D.H.-B., F.T.M., R.D.S., J.W.D.), University of Cincinnati College of Medicine; Division of Neurology (H.M.G., T.A.G., K.D.H.-B.), Cincinnati Children's Hospital Medical Center; Department of Neurology and Rehabilitation Medicine (D.M.F., J.L.C., L.E.), University of Cincinnati; Division of Neurosurgery (F.T.M.); Division of Biostatistics and Epidemiology (R.D.S.); and Division of Emergency Medicine (J.W.D.), Cincinnati Children's Hospital Medical Center, OH
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Rojulpote KV, Smith ML, Puka K, Speechley KN, Ferro MA, Connolly MB, Major P, Gallagher A, Almubarak S, Hasal S, Ramachandrannair R, Andrade A, Xu Q, Leung E, Snead OC, Widjaja E. Pre-Operative Predictors of Health-Related Quality of Life Two Years After Pediatric Epilepsy Surgery: A Prospective Cohort Study. Seizure 2023; 111:196-202. [PMID: 37683452 DOI: 10.1016/j.seizure.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Seizure freedom is an important predictor of health-related quality of life (HRQOL) after pediatric epilepsy surgery. This study aimed to identify the pre-operative predictors of HRQOL 2 years after epilepsy surgery in children with drug-resistant epilepsy. METHODS This multicenter prospective cohort study assessed pre-operative predictors including child (demographics and clinical variables), caregiver (including caregiver depressive and anxiety symptoms) and family characteristics. HRQOL was assessed using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55 pre-operatively and 2-years after surgery. Univariable linear regression analyses were done to identify significant preoperative predictors of HRQOL 2-years after surgery, followed by multivariable regression. RESULTS Ninety-five children underwent surgery, mean age was 11.4 (SD=4.2) years, and 59 (62%) were male. Mean QOLCE scores were 57.4 (95%CI: 53.8, 61.0) pre-operatively and 65.6 (95%CI: 62.0, 69.1) after surgery. Univariable regression showed fewer anti-seizure medications (ß=-6.1 [95%CI: -11.2, -1.0], p = 0.019), older age at seizure onset (ß=1.6 [95%CI: 0.8, 2.4], p<0.001), higher pre-operative HRQOL (ß=0.7 [95%CI: 0.5, 0.8], p<0.001), higher family resources (ß=0.6 [95%CI: 0.3, 0.9], p<0.001), better family relationships (ß=1.7 [95%CI: 0.3, 3.1], p = 0.017) and lower family demands (ß=-0.9 [95%CI: -1.5, -0.4], p<0.001) were associated with higher HRQOL after surgery. Caregiver characteristics did not predict HRQOL after surgery (p>0.05). Multivariable regression showed older age at seizure onset (ß=4.6 [95%CI: 1.6, 7.6], p = 0.003) and higher pre-operative HRQOL (ß=10.2 [95%CI: 6.8, 13.6], p<0.001) were associated with higher HRQOL after surgery. CONCLUSION This study underscores the importance of optimizing pre-operative HRQOL to maximize HRQOL outcome after pediatric epilepsy surgery.
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Affiliation(s)
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Philippe Major
- Division of Neurology, Department of Neurosciences, CHU Ste-Justine Hospital, University of Montreal, QC, Canada
| | - Anne Gallagher
- Centre de Recherche, CHU Ste-Justine Hospital, University of Montreal, QC, Canada
| | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada; Qatif Central Hospital, Qatif, Saudi Arabia
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Andrea Andrade
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Edward Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, Lurie Children's Hospital, Chicago, IL, USA.
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3
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Widjaja E, Puka K, Speechley KN, Ferro MA, Connolly MB, Major P, Gallagher A, Almubarak S, Hasal S, Ramachandrannair R, Andrade A, Xu Q, Leung E, Snead OC, Smith ML. Trajectory of Health-Related Quality of Life After Pediatric Epilepsy Surgery. JAMA Netw Open 2023; 6:e234858. [PMID: 36972050 PMCID: PMC10043749 DOI: 10.1001/jamanetworkopen.2023.4858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Importance Health-related quality of life (HRQOL) is regarded as a key outcome for evaluating treatment efficacy. However, it is uncertain how HRQOL evolves after epilepsy surgery compared with medical therapy, such as whether it continues to improve over time, improves and then remains stable, or deteriorates after a period of time. Objective To assess trajectory of HRQOL over 2 years in children with drug-resistant epilepsy (DRE) treated with surgery compared with medical therapy. Design, Setting, and Participants Prospective cohort study assessing HRQOL longitudinally over 2 years. Participants were children recruited from 8 epilepsy centers in Canada from 2014 to 2019 with suspected DRE aged 4 to 18 years who were evaluated for surgery. Data were analyzed from May 2014 to December 2021. Exposures Epilepsy surgery or medical therapy. Main Outcomes and Measures HRQOL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55. HRQOL and seizure frequency were assessed at baseline, 6-month, 1-year, and 2-year follow-ups. Clinical, parent, and family characteristics were assessed at baseline. A linear mixed model was used to evaluate HRQOL over time, adjusting for baseline clinical, parent, and family characteristics. Results There were 111 surgical and 154 medical patients (mean [SD] age at baseline was 11.0 [4.1] years; 118 [45%] were female). At baseline, HRQOL was similar among surgical and medical patients. HRQOL of surgical patients was 3.0 (95% CI, -0.7 to 6.8) points higher at 6-month, 4.9 (95% CI, 0.7 to 9.1) points higher at 1-year, and 5.1 (95% CI, 0.7 to 9.5) points higher at 2-year follow-ups compared with medical patients. Surgical patients experienced greater improvements in social functioning relative to medical patients, but not for cognitive, emotional, and physical functioning. At 2-year follow-up, 72% of surgical patients were seizure-free, compared with 33% of medical patients. Seizure-free patients reported higher HRQOL than those who were not. Conclusions and Relevance This study provided evidence on the association between epilepsy surgery and children's HRQOL, with improvement in HRQOL occurring within the first year and remaining stable 2 years after surgery. By demonstrating that surgery improved seizure freedom and HRQOL, which has downstream effects such as better educational attainment, reduced health care resource utilization, and health care cost, these findings suggest that the high costs of surgery are justified, and that improved access to epilepsy surgery is necessary.
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Affiliation(s)
- Elysa Widjaja
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, Lurie Children's Hospital, Chicago, Illinois
| | - Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Philippe Major
- Division of Neurology, Department of Pediatrics, CHU Ste-Justine Hospital, University of Montreal, Quebec, Canada
| | - Anne Gallagher
- Centre de Recherche, CHU Ste-Justine Hospital, University of Montreal, Quebec, Canada
| | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Qatif Central Hospital, Qatif, Saudi Arabia
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
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LoPresti MA, Huang J, Shlobin NA, Curry DJ, Weiner HL, Lam SK. Vagus nerve stimulator revision in pediatric epilepsy patients: a technical note and case series. Childs Nerv Syst 2023; 39:435-441. [PMID: 36434283 DOI: 10.1007/s00381-022-05769-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Vagus nerve stimulation (VNS) is an adjunctive treatment in children with intractable epilepsy. When lead replacement becomes necessary, the old leads are often truncated and retained and new leads are implanted at a newly exposed segment of the nerve. Direct lead removal and replacement are infrequently described, with outcomes poorly characterized. We aimed to describe our experience with feasibility of VNS lead removal and replacement in pediatric patients. METHODS Retrospective review examined 14 patients, at a single, tertiary-care, children's hospital, who underwent surgery to replace VNS leads, with complete removal of the existing lead from the vagus nerve and placement of a new lead on the same segment of the vagus nerve, via blunt and sharp dissection without use of electrocautery. Preoperative characteristics, stimulation parameters, and outcomes were collected. RESULTS Mean age at initial VNS placement was 7.6 years (SD 3.5, range 4.5-13.4). Most common etiologies of epilepsy were genetic (5, 36%) and cryptogenic (4, 29%). Lead replacement was performed at a mean of 6.0 years (SD 3.8, range 2.1-11.7) following initial VNS placement. Reasons for revision included VNS lead breakage or malfunction. There were no perioperative complications, including surgical site infection, voice changes, dysphagia, or new deficits postoperatively. Stimulation parameters after replacement surgery at last follow-up were similar compared to preoperatively, with final stimulation parameters ranging from 0.25 mA higher to 1.5 mA lower to maintain baseline seizure control. The mean length of follow-up was 7.9 years (SD 3.5, range 3.1-13.7). CONCLUSION Removal and replacement of VNS leads are feasible and can be safely performed in children. Further characterization of surgical technique, associated risk, impact on stimulation parameters, and long-term outcomes are needed to inform best practices in VNS revision.
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Affiliation(s)
- Melissa A LoPresti
- Division of Pediatric Neurosurgery, Texas Children's Hospital; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.,Division of Pediatric Neurosurgery, Lurie Children's Hospital; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan Huang
- Division of Pediatric Neurosurgery, Lurie Children's Hospital; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan A Shlobin
- Division of Pediatric Neurosurgery, Lurie Children's Hospital; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Texas Children's Hospital; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Howard L Weiner
- Division of Pediatric Neurosurgery, Texas Children's Hospital; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Lurie Children's Hospital; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Almojuela A, Xu Q, O'Carroll A, MacDonald C, Ritchie L, Serletis D. Development of a Pediatric Epilepsy Program: Analysis of Early Multidimensional Outcomes. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1742607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background A Pediatric Epilepsy Program was instituted in Manitoba in 2016. This report seeks to describe changes in the management of pediatric epilepsy patients in Manitoba since the inception of this Program, to provide an early analysis of local outcomes, and to present a framework for further program development.
Methods Data was collected for patients treated both before and after inception of the Program. Caregivers completed questionnaires on quality of life and program satisfaction. An online database was created to capture demographic information, seizure and quality of life outcomes, and caregiver satisfaction ratings. Descriptive statistics were used to summarize the results.
Results Prior to commencement of the Program, 16 patients underwent vagal nerve stimulator (VNS) insertion. At last follow-up, 6.25% of patients achieved Engel class I outcome, 75% achieved class III outcome, and 18.75% were classified as class IV. Following inception of the Program, 11 patients underwent resective procedures and 3 underwent VNS insertions. At last follow-up, 78.6% of patients achieved Engel class I outcome, 14.3% achieved class III outcome, and 7.1% were classified as class IV. Since inception of the Program, the average Quality of Life in Childhood Epilepsy Questionnaire-55 score measuring patient quality of life was (59.7 ± 23.2)/100. The average Care-Related Quality of Life-7D score measuring caregiver quality of life was (78.3 ± 18.6)/100. Caregiver satisfaction had an average rating of (9.4 ± 0.8)/10.
Conclusion Access to epilepsy surgery has significantly improved for children in Manitoba and has led to favorable, early multidimensional outcomes. Structural organization, funding, and multidisciplinary engagement are necessary for program sustainability and growth.
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Affiliation(s)
- Alysa Almojuela
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, Section of Pediatric Neurology, University of Manitoba, Winnipeg, Canada
| | - Aoife O'Carroll
- Department of Pediatrics and Child Health, Section of Pediatric Neurology, University of Manitoba, Winnipeg, Canada
| | - Carling MacDonald
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley Ritchie
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Demitre Serletis
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, United States
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Shlobin NA, Campbell JM, Rosenow JM, Rolston JD. Ethical considerations in the surgical and neuromodulatory treatment of epilepsy. Epilepsy Behav 2022; 127:108524. [PMID: 34998267 PMCID: PMC10184316 DOI: 10.1016/j.yebeh.2021.108524] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 02/08/2023]
Abstract
Surgical resection and neuromodulation are well-established treatments for those with medically refractory epilepsy. These treatments entail important ethical considerations beyond those which extend to the treatment of epilepsy generally. In this paper, the authors explore these unique considerations through a framework that relates foundational principles of bioethics to features of resective epilepsy surgery and neuromodulation. The authors conducted a literature review to identify ethical considerations for a variety of epilepsy surgery procedures and to examine how foundational principles in bioethics may inform treatment decisions. Healthcare providers should be cognizant of how an increased prevalence of somatic and psychiatric comorbidities, the dynamic nature of symptom burden over time, the individual and systemic barriers to treatment, and variable sociocultural contexts constitute important ethical considerations regarding the use of surgery or neuromodulation for the treatment of epilepsy. Moreover, careful attention should be paid to how resective epilepsy surgery and neuromodulation relate to notions of patient autonomy, safety and privacy, and the shared responsibility for device management and maintenance. A three-tiered approach-(1) gathering information and assessing the risks and benefits of different treatment options, (2) clear communication with patient or proxy with awareness of patient values and barriers to treatment, and (3) long-term decision maintenance through continued identification of gaps in understanding and provision of information-allows for optimal treatment of the individual person with epilepsy while minimizing disparities in epilepsy care.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Justin M Campbell
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Neuroscience, University of Utah, Salt Lake City, UT, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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Trigg A, Brohan E, Cocks K, Jones A, Tahami Monfared AA, Chabot I, Meier G, Campbell R, Li H, Ngo LY. Health-related quality of life in pediatric patients with partial onset seizures or primary generalized tonic-clonic seizures receiving adjunctive perampanel. Epilepsy Behav 2021; 118:107938. [PMID: 33839450 DOI: 10.1016/j.yebeh.2021.107938] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE Study 311 (E2007-G000-311; NCT02849626) was a Phase 3, multicenter, open-label single-arm study of adjunctive perampanel oral suspension in pediatric patients (aged 4 to <12 years) with partial-onset seizures (POS) (with/without secondarily generalized tonic-clonic seizures [SGTCS]) or primary generalized tonic-clonic seizures (PGTCS). Health-related quality of life (HRQoL) was an exploratory endpoint initially analyzed through simple descriptive summaries. The aim of this post hoc analysis was to provide a more thorough assessment of HRQoL. METHODS This analysis focused on EQ-5D-Y data collected at Baseline, Week 23, and Week 52. Individual dimensions, visual analog scale (VAS) and summed misery index (MI) were evaluated at all visits and compared by seizure type (POS versus SGTCS versus PGTCS), age (4 to <7 versus 7 to <12), and use of concomitant enzyme-inducing antiepileptic drugs (EIAEDs) (yes versus no). Paretian Classification of Health Change (PCHC) analysis summarized the proportion of patients who showed improvement or deterioration in HRQoL. Waterfall plots assessed changes in EQ-5D-Y scores by treatment-emergent adverse events (TEAEs) and by reduction in seizure frequency. Health state utility values associated with differing seizure frequency states were estimated using a linear mixed model. RESULTS One hundred and fifteen patients completed EQ-5D-Y at relevant study visits (Seizure type: POS n = 84 [of which 21 had SGTCS], PGTCS n = 31; Age: 4 to <7 years n = 30, 7 to <12 years n = 85; Concomitant EIAEDs: Yes n = 35, No n = 80). Completion rates out of those expected to complete EQ-5D-Y were high at both timepoints (84.4% at Week 23 and 97.2% at Week 52). Overall, VAS/MI remained stable over time (did not exceed minimal important difference); this was similar according to seizure type, age, and EIAED usage. In patients with 'no problems' on any EQ-5D-Y dimension at Baseline, nearly all retained their full health at Week 23 (94.7%), and all retained it at Week 52 (100.0%). PCHC analysis showed fewer patients with POS experienced deterioration in EQ-5D-Y than patients with PGTCS at Week 23 (24.1% versus 42.1%). Not experiencing a TEAE, or remaining seizure-free, was associated with improvements in VAS score at Week 23 compared to those experiencing TEAEs or seizures, respectively. Health state utility values (HSUVs) were estimated as follows: seizure free (LS Mean 0.914 [95% CIs 0.587, 1.240]), ≥1 seizure per year (0.620 [0.506, 0.734]), ≥1 seizure per month (0.596 [0.338, 0.855]), ≥1 seizure per week (0.284 [-0.014, 0.582]). CONCLUSIONS An in-depth analysis of EQ-5D-Y data allowed for a more nuanced exploration of HRQoL than previous descriptive summaries. Our findings provide evidence that perampanel as adjunctive therapy did not result in deterioration of patient HRQoL. The association between TEAEs or remaining seizure-free and HRQoL warrants further exploration. Increasing seizure frequency was associated with decreasing HSUVs; these can inform cost-effectiveness modeling of perampanel and other therapies aiming to reduce seizure frequency in pediatric patients.
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Affiliation(s)
- Andrew Trigg
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK.
| | - Elaine Brohan
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK
| | - Kim Cocks
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK
| | - Amy Jones
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK
| | - Amir A Tahami Monfared
- Eisai Inc., Woodcliff Lake, NJ, USA; McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, QC, Canada
| | - Isabelle Chabot
- Faculty of Pharmacy, Montreal University, Montreal, QC, Canada
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8
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Yan H, Siegel L, Breitbart S, Gorodetsky C, Gonorazky HD, Yau I, Go C, Donner E, Kalia SK, Fasano A, Weil AG, Fallah A, Ibrahim GM. The Child & Youth CompreHensIve Longitudinal Database for Deep Brain Stimulation (CHILD-DBS). Childs Nerv Syst 2021; 37:607-615. [PMID: 32935233 DOI: 10.1007/s00381-020-04880-4] [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: 08/17/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Deep brain stimulation (DBS) is a common tool for the treatment of movement disorders in adults; however, it remains an emerging treatment modality in children with a growing number of indications, including epilepsy and dystonia. The Child & Youth CompreHensIve Longitudinal Database of DBS (CHILD-DBS) study aims to prospectively collect relevant data on quality of life (QoL), safety, efficacy, and long-term neurodevelopmental outcomes following DBS in children. METHODS Data are collected and managed using the Research Electronic Data Capture (REDCap). This database aims to collect multicentre comprehensive and longitudinal clinical, QoL, imaging and electrophysiologic data for children under the age of 19 undergoing DBS. RESULTS Both general and indication-specific measures are collected at baseline and at four time points postoperatively: 6 months, 1 year, 2 years, and 3 years. The database encompasses QoL metrics for children, including the PedsQL (Pediatric Quality of Life Inventory, generic), QOLCE (Quality of Life in Childhood Epilepsy Questionnaire, parent-rated), CHU 9D (Child Health Utility 9D), and KIDSCREEN. Caregiver clinical and QoL metrics, including QIDS (Quick Inventory of Depressive Symptomatology), GAD-7 (Generalized Anxiety Disorder 7-item scale), and CarerQoL-7D (The Care-related Quality of Life Instrument), are similarly prospectively collected. Healthcare resource utilization is also assessed before and after DBS. Lastly, stimulation parameters and radiographic and electrophysiologic data are collected within the database. CONCLUSIONS The development of the current prospective paediatric DBS database with carefully selected physical and psychosocial outcomes and assessments will complement existing efforts to enhance and facilitate multisite collaboration to further understand the role of DBS in childhood.
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Affiliation(s)
- Han Yan
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada.,Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Siegel
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sara Breitbart
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carolina Gorodetsky
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hernan D Gonorazky
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ivanna Yau
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cristina Go
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Donner
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada.,University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Alexander G Weil
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Division of Neurosurgery and Pediatrics, Sainte Justine Hospital, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada. .,Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada. .,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada. .,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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9
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Leal STF, Santos MV, Thomé U, Machado HR, Escorsi-Rosset S, Dos Santos AC, Wichert-Ana L, Leite JP, Fernandes RMF, Sakamoto AC, Hamad APA. Impact of epilepsy surgery on quality of life and burden of caregivers in children and adolescents. Epilepsy Behav 2020; 106:106961. [PMID: 32199346 DOI: 10.1016/j.yebeh.2020.106961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to analyze the impact of pediatric epilepsy surgery on the quality of life (QOL), determining whether patients improve, worsen, or maintain their preoperative patterns, as it relates to the burden of caregivers, as well as evaluating potential related factors, from both the children and caregivers perspectives. MATERIAL AND METHODS This is a retrospective study of children and adolescents who underwent epilepsy surgery and were evaluated through clinical data, videoelectroencephalogram (V-EEG), neuroimaging findings, neuropsychological testing, and aspects of QOL. These assessments were performed prior to surgery and after six months and two years of follow-up. Quality of life was assessed with epilepsy-specialized questionnaires, namely Questionnaire health-related quality of life for children with epilepsy (QVCE-50), Autoquestionnaire Qualité de Vie Enfant Image Scale (AUQUEI), Quality of life in epilepsy inventory for adolescents (QOLEI-AD-48); and burden of caregivers with Burden Interview - ZARIT scale. Postoperative changes in QVCE-50 were quantified using measures of the analysis of variance (ANOVA MR) for comparison of the difference between the three times of the scale and domains. RESULTS Fifty patients were enrolled. Of these, 27 (54%) were male, with a mean age at surgery of 8.2 years (range: 1-18 years). Thirty-five patients (70%) were Engel I and one was Engel II (2%) at six months of follow-up, whereas 28 (56%) were Engel I and 32 (64%) were Engel I or II at two years of follow-up. Preoperatively, 21 (42%) presented with moderate or severe intellectual disability. Postoperative cognitive evaluations at the two-year follow-up showed 18 (36%) maintained similar deficits. The QVCE-50 showed postoperative improvement in the two-year follow-up period, but not at six months after surgery. Postoperative improvements were associated mainly with better seizure outcome. Autoperception evaluations were limited because of the clinical and cognitive severity of patients. The burden of caregivers was quoted as mild to moderate and remained unchanged postoperatively. CONCLUSIONS Children and adolescents with surgically treated epilepsy reach a good seizure outcome, stabilize in intellectual and adaptive functions, and have an increase in QOL, from the caregiver's perspective. Nevertheless, their burden remains unchanged. Seizure outcome is the main factor for improvement in the QOL. The upgrading of structured questionnaires and QOL instruments specific to pediatric epilepsy can be helpful to assess patient- and caregiver-reported surgical outcomes, allowing for better planning of therapeutic approaches.
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Affiliation(s)
- Suenia Timotheo Figueiredo Leal
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcelo Volpon Santos
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Division of Pediatric Neurosurgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ursula Thomé
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Helio Rubens Machado
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Division of Pediatric Neurosurgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Sara Escorsi-Rosset
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Radiology Division-Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Antônio Carlos Dos Santos
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Radiology Division-Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Lauro Wichert-Ana
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Section of Nuclear Medicine, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Pereira Leite
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Regina Maria França Fernandes
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ameriko Ceiki Sakamoto
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Paula Andrada Hamad
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
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10
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Jain P, Smith ML, Speechley K, Ferro M, Connolly M, Ramachandrannair R, Almubarak S, Andrade A, Widjaja E. Seizure freedom improves health-related quality of life after epilepsy surgery in children. Dev Med Child Neurol 2020; 62:600-608. [PMID: 31709524 DOI: 10.1111/dmcn.14390] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2019] [Indexed: 12/11/2022]
Abstract
AIM To determine whether epilepsy surgery improved health-related quality of life (HRQoL) and whether seizure freedom after surgery mediated the improvement in HRQoL. METHOD This multicenter cohort study compared HRQoL after epilepsy surgery to pharmacological management in children with drug-resistant epilepsy (DRE). HRQoL was measured using the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire at baseline and 1-year follow-up. The mediator between treatment type and HRQoL was seizure freedom. RESULTS Two hundred and thirty-seven patients were recruited (surgery group: n=147 [92 males, 45 females]; pharmacological group: n=90 [53 males, 37 females]). Mean age at seizure onset was 6 years (SD 4y 4mo) in the surgical group and 6 years 1 month (SD 4y) in the pharmacological group. The odds ratio of seizure freedom was higher for the surgery versus pharmacological group (β=4.24 [95% confidence interval {CI}: 2.26-7.93], p<0.001). Surgery had no direct effect on total QOLCE score at 1-year (β=0.24 [95% CI -2.04 to 2.51], p=0.839) compared to pharmacological management, but had an indirect effect on total QOLCE that was mediated by seizure freedom (β=0.92 [95% CI 0.19-1.65], p=0.013), adjusting for baseline total QOLCE score. Surgery had a direct effect on improving social function (p=0.043), and an indirect effect on improving physical function (p=0.016), cognition (p=0.042), social function (p=0.012) and behavior (p=0.032), mediated by seizure freedom. INTERPRETATION Greater seizure freedom achieved through epilepsy surgery mediated the improvement in HRQoL compared to pharmacological management in children with DRE. WHAT THIS PAPER ADDS Seizure freedom is higher after pediatric epilepsy surgery compared to pharmacologically managed epilepsy. Surgery indirectly improves health-related quality of life (HRQoL) mediated by seizure freedom compared to pharmacological management. Surgery has a direct effect on improving social function relative to pharmacological management. Baseline HRQoL was an important predictor of HRQoL after treatment.
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Affiliation(s)
- Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Pediatric Neurology, Department of Pediatrics, BLK Super Speciality Hospital, New Delhi, India.,Division of Pediatric Neurology, Department of Pediatrics, Danat Al Emarat Hospital for Women and Children, Abu Dhabi, UAE
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathy Speechley
- Department of Paediatrics, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Mark Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Andrea Andrade
- Department of Pediatrics, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Elysa Widjaja
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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11
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Lin PT, Yu HY, Lu YJ, Wang WH, Chou CC, Hsu SPC, Lin CF, Lee CC. Social functioning and health-related quality of life trajectories in people with epilepsy after epilepsy surgery. Epilepsy Behav 2020; 103:106849. [PMID: 31884120 DOI: 10.1016/j.yebeh.2019.106849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/27/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE An improvement in quality of life (QoL) over time after epilepsy surgery has been demonstrated in people with epilepsy; however, social functioning has been less investigated. We conducted this study to examine whether postsurgical improvement is parallel between QoL and social functioning in patients with epilepsy. METHODS We retrospectively reviewed patients who underwent epilepsy surgery. All participants completed a comprehensive neuropsychological assessment, the Quality of Life in Epilepsy Inventory (QOLIE-89) questionnaire, and the Social and Occupational Functioning Scale for Epilepsy (SOFSE) before surgery and at 3 months, 6 months, and 1 year after surgery. Demographic and epilepsy-related information was also collected. Generalized estimating equations with identity links were used to model the QOLIE-89 and SOFSE over time and possible associated factors. A p < 0.05 was considered statistically significant. RESULTS A total of 76 patients, including 36 males and 43 females aged 18 to 62 years were collected. Both total QOLIE-89 and overall SOFSE improved over time after epilepsy surgery (adjusted p value < 0.001 and 0.002, respectively, with Bonferroni's correction). Total QOLIE-89 improved 3 months after surgery, while overall SOFSE showed no significant improvement until 6 months after surgery. The presurgical Full-Scale Intelligence Quotient (FSIQ) of the Wechsler Adult Intelligence Scale-III and years of education were significantly associated with time-dependent improvement for both total QOLIE-89 and overall SOFSE (p value < 0.001). At one year after surgery, overall SOFSE and total QOLIE-89 scores were significantly higher in the seizure-free group than in the nonseizure-free group (p value = 0.040 and 0.032, respectively). CONCLUSION Social functioning significantly improved in people with epilepsy after surgery as QoL, but it took more time to exhibit improvement. People with better FSIQ and more years of education had better improvement in social functioning over time. The early intervention of rehabilitation programs after epilepsy surgery might be necessary to facilitate the improvement in social functioning.
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Affiliation(s)
- Po-Tso Lin
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
| | - Yi-Jiun Lu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Han Wang
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
| | - Chien-Chen Chou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Sanford P C Hsu
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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12
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Yang Z, Zhang C, Wang Z, Cheng T, Qin X, Deng J, Fang X, Hao H, Peng J, Yin F, Li L. Vagal nerve stimulation is effective in pre-school children with intractable epilepsy: A report of two cases. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
There is lack of prospective evidence regarding vagal nerve stimulator (VNS) in younger children with intractable epilepsy. Here, we report the outcomes of using VNS in two pre-school patients for pediatric intractable epilepsy (VNS-PIE) study. Medical treatment was ineffective in both the patients, and they underwent VNS implantation. Seizure frequency, score on the Gesell scale, and heart rate variability (HRV) were assessed following VNS therapy. After 6 months VNS treatment, the seizure frequency in the two patients decreased by 50% from that at baseline, based on the records in their epileptic diary. Video electroencephalography (EEG) examinations showed that abnormal fast waves diminished in the background in Patient 1, and captured seizure frequency in Patient 2 remarkably decreased. The adaptability, language, and individual and social interaction on their Gesell scales increased slightly, suggesting that VNS had a positive effect on the development of these two children. Moreover, the changes in the different HRV indices indicated improved cardiac autonomic function. In conclusion, these two cases indicated that VNS may not only be a superior therapy for pre-school children with intractable epilepsy, but also may exert a positive effect on their mental development and cardiac autonomic function.
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13
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Braams O, Maher C, Jennekens-Schinkel A, Braun K, van Nieuwenhuizen O, van Schooneveld M, Schappin R. Social functioning of children after epilepsy surgery: A literature review. Epilepsy Behav 2019; 96:210-218. [PMID: 31174069 DOI: 10.1016/j.yebeh.2019.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022]
Abstract
This literature review on social functioning of children after epilepsy surgery is based on 24 papers addressing two categories of social functioning: social cognition (n = 4) and general social functioning (n = 20). Overall, studies that compared with healthy peers revealed children who had undergone epilepsy surgery to have more problems in both social cognition and general social functioning. Half of the studies found some improvement in social functioning in the first year(s) after epilepsy surgery, but this pertained to general social functioning, not to social cognition. The persistence of the problems in social cognition after surgery may be related to the critical period of brain maturation, lacking improvement of impairments in related cognitive domains or to a defective underlying brain condition - rather than to the epilepsy. Problems in general social functioning may be explained by the adjustments the children and their families had to make because of the child's drug-resistant epilepsy and difficulties to adjust to the new situation after surgery. The neurological and behavioral explanations are likely to be interrelated in light of the multifaceted and complex nature of social functioning. Epilepsy surgery does not appear to solve the problems in social functioning associated with having had drug-resistant epilepsy. As social functioning is an important aspect of healthy development, it should be assessed comprehensively in order to obtain a knowledge base that allows 1) proper treatment of children with epilepsy (CwE) and 2) counseling patients and families prior to and after epilepsy surgery.
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Affiliation(s)
- Olga Braams
- Department of Pediatric Psychology and Social Work, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Caragh Maher
- Department of Pediatric Psychology and Social Work, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands.
| | - Aag Jennekens-Schinkel
- Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Kees Braun
- Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Child Neurology, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands.
| | - Onno van Nieuwenhuizen
- Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Monique van Schooneveld
- Department of Pediatric Psychology and Social Work, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Renske Schappin
- Department of Pediatric Psychology and Social Work, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands.
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14
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Weinstock A, Agarwal N, Farooq O, Cheema Z, Hamilton D, Parrish J. Evaluation of the Effects of Clobazam on Seizure Control and Quality of Life in Children With Lennox-Gastaut Syndrome: A Pilot Study. J Child Neurol 2019; 34:432-439. [PMID: 30913948 DOI: 10.1177/0883073819836534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This is a prospective study of children with Lennox-Gastaut syndrome receiving clobazam as adjunctive therapy. This pilot study aims to examine medication effectiveness as it relates to seizure reduction, as well as improvement in parent-reported behavior and quality of life (QOL). METHODS Ten patients with Lennox-Gastaut syndrome aged 3-11 years were enrolled in this 6-week, 4 phase study. Seizure frequency, QOL, and Aberrant Behavior Checklist questionnaires were evaluated at 0, 2, 6, and 10 weeks during the study. RESULTS Patients showed improvement on indices of QOL, including physical activities (62.5%), well-being (37.5%), cognition (87.5%), social activities (37.5%), behavior (87.5%), general health (50%), and overall QOL (87.5%). The Quality of Life in Childhood Epilepsy (QOLCE) questionnaire revealed significant improvement in cognition (P = .008), social activities (P = .049), behavior (P = .038), and overall QOL (P = .018). The Aberrant Behavior Checklist exhibited a trend toward improvement in hyperactivity. CONCLUSION There was improvement in all patients with documented baseline seizures (8/10), with 5 showing significant improvement (95%-100% reduction) and 3 showing minor improvement (7%-23% reduction). Statistically significant improvement in areas of cognition, social activities, behavior, and overall QOL were seen. An overall trend toward a positive well-being was seen in our patients with clobazam, as adjunct therapy for Lennox-Gastaut syndrome in children.
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Affiliation(s)
- Arie Weinstock
- 1 Division of Child Neurology, The Women and Children's Hospital of Buffalo, Buffalo, NY, USA.,2 Department of Neurology, Jacobs School of Medicine at the University at Buffalo, Buffalo, NY, USA
| | | | - Osman Farooq
- 1 Division of Child Neurology, The Women and Children's Hospital of Buffalo, Buffalo, NY, USA.,2 Department of Neurology, Jacobs School of Medicine at the University at Buffalo, Buffalo, NY, USA
| | - Zaheer Cheema
- 1 Division of Child Neurology, The Women and Children's Hospital of Buffalo, Buffalo, NY, USA.,2 Department of Neurology, Jacobs School of Medicine at the University at Buffalo, Buffalo, NY, USA
| | - Deanna Hamilton
- 1 Division of Child Neurology, The Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - Joy Parrish
- 2 Department of Neurology, Jacobs School of Medicine at the University at Buffalo, Buffalo, NY, USA
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Reilly C, Baldeweg T, Stewart N, Wadhwani S, Jones C, Helen Cross J, Heyman I. Do behavior and emotions improve after pediatric epilepsy surgery? A systematic review. Epilepsia 2019; 60:885-897. [DOI: 10.1111/epi.14737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Colin Reilly
- Research Department Young Epilepsy Lingfield UK
- University College London Great Ormond Street Institute of Child Health London UK
| | - Torsten Baldeweg
- University College London Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children National Health Service Trust London UK
| | - Neil Stewart
- University College London Great Ormond Street Institute of Child Health London UK
| | - Suresh Wadhwani
- University College London Great Ormond Street Institute of Child Health London UK
| | - Chloe Jones
- Research Department Young Epilepsy Lingfield UK
- University College London Great Ormond Street Institute of Child Health London UK
| | - J. Helen Cross
- Research Department Young Epilepsy Lingfield UK
- University College London Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children National Health Service Trust London UK
| | - Isobel Heyman
- University College London Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children National Health Service Trust London UK
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Ji T, Yang Z, Liu Q, Liao J, Yin F, Chen Y, Zou L, Li B, Gao Y, Shu X, Huang S, Gao F, Liang J, Lin SF, Peng J, Song S, Wang J, Che C, Sun W, Tian M, Yang L, Hua Y, Hao Y, Cai L, Li L, Jiang Y. Vagus nerve stimulation for pediatric patients with intractable epilepsy between 3 and 6 years of age: study protocol for a double-blind, randomized control trial. Trials 2019; 20:44. [PMID: 30642370 PMCID: PMC6332620 DOI: 10.1186/s13063-018-3087-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/30/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recent clinical observations have reported the potential benefit of vagus nerve stimulation (VNS) as an adjunctive therapy for pediatric epilepsy. Preliminary evidence suggests that VNS treatment is effective for seizure reduction and mental development in young participants between 3 and 6 years of age who suffer from intractable epilepsy. However, robust clinical evidence for quantifying the difference of the efficacy and safety of VNS treatment in this specific patient population has yet to be reported. METHODS/DESIGN A two-armed, multicenter, randomized, double-blind, prospective trial will be carried out to evaluate whether VNS is beneficial and safe for pediatric epilepsy. Pediatric participants aged between 3 to 6 years old with intractable epilepsy will be recruited and randomly assigned to experimental and control groups with a 1:1 allocation using a computer-generating randomization schedule. Before enrollment, informed consent will be signed by the parents of the participants and the study researchers. Participants in the experimental group will receive electrical stimulation over 24 weeks under standard stimulation parameters. Participants in the control group will not receive any stimulation during the 12 weeks of the double-blind period. The guardians of the participants are required to keep a detailed diary to record seizure activity. Outcome assessments including seizure frequency, Gesell Mental Developmental Scale scores, use of antiepileptic drugs and dosages, and adverse events will be collected at baseline, 6, 12, 18 and/or 24 weeks after electrical stimulation is initiated. The effects of treatment will be analyzed with time and treatment group comparisons. DISCUSSION This trial will evaluate quantitative differences in efficacy and safety with/without VNS treatment for pediatric participants aged between 3 to 6 years with intractable epilepsy and will explore whether the current age range of VNS therapy can be expanded. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03062514 , Registered on 23 February 2017.
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Affiliation(s)
- Taoyun Ji
- 0000 0004 1764 1621grid.411472.5Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, No.1 Xi’an Men Street, West District, Beijing, 100034 China
- 0000 0004 1764 1621grid.411472.5Department of Pediatric Epilepsy Center, Peking University First Hospital, No.1 Xi’an Men Street, West District, Beijing, 100034 China
| | - Zhao Yang
- 0000 0001 0662 3178grid.12527.33National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Qingzhu Liu
- 0000 0004 1764 1621grid.411472.5Department of Pediatric Epilepsy Center, Peking University First Hospital, No.1 Xi’an Men Street, West District, Beijing, 100034 China
| | - Jianxiang Liao
- 0000 0004 1806 5224grid.452787.bDepartment of Neurology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Fei Yin
- 0000 0004 1757 7615grid.452223.0Department of Pediatrics, Xiangya Hospital of Central South University, Changsha, Hunan China
- Hunan Intellectual and Developmental Disabilities Research Center of Children, Changsha, Hunan China
| | - Yanhui Chen
- 0000 0004 1758 0478grid.411176.4Division of Pediatric Neurology, Pediatrics Department, Fujian Medical University Union Hospital, Fuzhou, China
- 0000 0004 1758 0478grid.411176.4Department of Epilepsy Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liping Zou
- 0000 0004 1761 8894grid.414252.4Department of Pediatric, Chinese PLA General Hospital, Beijing, China
| | - Baomin Li
- grid.452402.5Pediatics Department, Qilu Hospital of Shandong University, Jinan, Shandong China
| | - Yuxing Gao
- 0000 0004 1769 9639grid.460018.bDivision of Pediatrics Neurology, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaomei Shu
- grid.413390.cDepartment of Pediatrics, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou China
| | - Shaoping Huang
- grid.452672.0Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Feng Gao
- grid.411360.1Department of Neurology, The Children’s Hospital, ZheJiang University School of Medicine, Hangzhou, China
| | - Jianmin Liang
- grid.452451.3Department of Pediatric Neurology, First Bethune Hospital, Jilin University, Changchun, China
- grid.452451.3Research Center of Neuroscience, First Bethune Hospital, Jilin University, Changchun, China
| | - Su Fang Lin
- 0000 0004 1806 5224grid.452787.bDepartment of Neurology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Jing Peng
- 0000 0004 1757 7615grid.452223.0Department of Pediatrics, Xiangya Hospital of Central South University, Changsha, Hunan China
- Hunan Intellectual and Developmental Disabilities Research Center of Children, Changsha, Hunan China
| | - Shiwei Song
- 0000 0004 1758 0478grid.411176.4Department of Epilepsy Center, Fujian Medical University Union Hospital, Fuzhou, China
- 0000 0004 1758 0478grid.411176.4Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jing Wang
- 0000 0004 1761 8894grid.414252.4Department of Pediatric, Chinese PLA General Hospital, Beijing, China
| | - Chao Che
- grid.452402.5Pediatics Department, Qilu Hospital of Shandong University, Jinan, Shandong China
| | - Wenxiu Sun
- 0000 0004 1769 9639grid.460018.bDivision of Pediatrics Neurology, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Maoqiang Tian
- grid.413390.cDepartment of Pediatrics, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou China
| | - Lin Yang
- grid.452672.0Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yi Hua
- grid.411360.1Department of Neurology, The Children’s Hospital, ZheJiang University School of Medicine, Hangzhou, China
| | - Yunpeng Hao
- grid.452451.3Department of Pediatric Neurology, First Bethune Hospital, Jilin University, Changchun, China
| | - Lixin Cai
- 0000 0004 1764 1621grid.411472.5Department of Pediatric Epilepsy Center, Peking University First Hospital, No.1 Xi’an Men Street, West District, Beijing, 100034 China
| | - Luming Li
- 0000 0001 0662 3178grid.12527.33National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
- 0000 0001 0662 3178grid.12527.33Man-Machine-Environment Engineering Institute, School of Aerospace Engineering, Tsinghua University, Room_204, North Part, Mengminwei Technology Building, Beijing, 100084 China
- grid.499361.0Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China
- 0000 0004 0369 153Xgrid.24696.3fCenter of Epilepsy, Beijing Institute for Brain Disorders, Beijing, 100069 China
| | - Yuwu Jiang
- 0000 0004 1764 1621grid.411472.5Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, No.1 Xi’an Men Street, West District, Beijing, 100034 China
- 0000 0004 1764 1621grid.411472.5Department of Pediatric Epilepsy Center, Peking University First Hospital, No.1 Xi’an Men Street, West District, Beijing, 100034 China
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Maragkos GA, Geropoulos G, Kechagias K, Ziogas IA, Mylonas KS. Quality of Life After Epilepsy Surgery in Children: A Systematic Review and Meta-Analysis. Neurosurgery 2018; 85:741-749. [DOI: 10.1093/neuros/nyy471] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/20/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Pediatric epilepsy surgery is a treatment modality appropriate for select patients with debilitating medication-resistant seizures. Previous publications have studied seizure freedom as the main outcome of epilepsy surgery. However, there has been no systematic assessment of the postoperative life quality for these children.
OBJECTIVE
To estimate the quality of life (QOL) long-term outcomes after surgery for intractable epilepsy in pediatric patients.
METHODS
A systematic search of the PubMed and Cochrane databases was performed. Studies reporting questionnaire-assessed QOL at least 12 months postoperatively were included. QOL means and standard deviations were compared between surgically and medically managed patients, between the preoperative and postoperative state of each patient, and were further stratified into patients achieving seizure freedom, and those who did not. Meta-analysis was performed using fixed effects models for weighted mean differences (WMD), 95% confidence intervals (CI) and sensitivity analyses. Funnel plots and Begg's tests were utilized to detect publication bias.
RESULTS
The search yielded 18 retrospective studies, reporting 890 surgical patients. Following epilepsy surgery, children had significant QOL improvement compared to their preoperative state (WMD: 16.71, 95% CI: 12.19-21.22, P < .001) and better QOL than matched medically treated controls (WMD: 12.42, 95% CI: 6.25-18.58, P < .001). Patients achieving total seizure freedom after surgery had significant postoperative QOL improvement (WMD: 16.12, 95% CI: 7.98-24.25, P < .001), but patients not achieving seizure freedom did not achieve statistical significance (P = .79).
CONCLUSION
Epilepsy surgery can effectively improve QOL in children with medication-resistant seizures, through seizure freedom, which was associated with the greatest improvement in life quality.
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Affiliation(s)
- Georgios A Maragkos
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Georgios Geropoulos
- Pediatric Surgery Working Group, Society of Junior Doctors, Athens, Greece
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ioannis A Ziogas
- Pediatric Surgery Working Group, Society of Junior Doctors, Athens, Greece
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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18
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Reithmeier D, Tang-Wai R, Seifert B, Lyon AW, Alcorn J, Acton B, Corley S, Prosser-Loose E, Mousseau DD, Lim HJ, Tellez-Zenteno J, Huh L, Leung E, Carmant L, Huntsman RJ. The protocol for the Cannabidiol in children with refractory epileptic encephalopathy (CARE-E) study: a phase 1 dosage escalation study. BMC Pediatr 2018; 18:221. [PMID: 29981580 PMCID: PMC6035794 DOI: 10.1186/s12887-018-1191-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Initial studies suggest pharmaceutical grade cannabidiol (CBD) can reduce the frequency of convulsive seizures and lead to improvements in quality of life in children affected by epileptic encephalopathies. With limited access to pharmaceutical CBD, Cannabis extracts in oil are becoming increasingly available. Physicians show reluctance to recommend Cannabis extracts given the lack of high quality safety data especially regarding the potential for harm caused by other cannabinoids, such as Δ9-tetrahydrocannabinol (Δ9-THC). The primary aims of the study presented in this protocol are (i) To determine whether CBD enriched Cannabis extract is safe and well-tolerated for pediatric patients with refractory epilepsy, (ii) To monitor the effects of CBD-enriched Cannabis extract on the frequency and duration of seizure types and on quality of life. METHODS Twenty-eight children with treatment resistant epileptic encephalopathy ranging in age from 1 to 10 years will be recruited in four Canadian cities into an open-label, dose-escalation phase 1 trial. The primary objectives for the study are (i) To determine if the CBD-enriched Cannabis herbal extract is safe and well-tolerated for pediatric patients with treatment resistant epileptic encephalopathy and (ii) To determine the effect of CBD-enriched Cannabis herbal extract on the frequency and duration of seizures. Secondary objectives include (i) To determine if CBD-enriched Cannabis herbal extracts alter steady-state levels of co-administered anticonvulsant medications. (ii) To assess the relation between dose escalation and quality of life measures, (iii) To determine the relation between dose escalation and steady state trough levels of bioactive cannabinoids. (iv) To determine the relation between dose escalation and incidence of adverse effects. DISCUSSION This paper describes the study design of a phase 1 trial of CBD-enriched Cannabis herbal extract in children with treatment-resistant epileptic encephalopathy. This study will provide the first high quality analysis of safety of CBD-enriched Cannabis herbal extract in pediatric patients in relation to dosage and pharmacokinetics of the active cannabinoids. TRIAL REGISTRATION http://clinicaltrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2016 Dec 16. Identifier NCT03024827, Cannabidiol in Children with Refractory Epileptic Encephalopathy: CARE-E; 2017 Jan 19 [cited 2017 Oct]; Available from: http://clinicaltrials.gov/ct2/show/NCT03024827.
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Affiliation(s)
- Darren Reithmeier
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Room E3210 Health Sciences 104 Clinic Place, Saskatoon, SK S7N-2Z4 Canada
| | - Richard Tang-Wai
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Department of Pediatrics, Division of Child Neurology, Loma Linda University, Loma Linda, California, USA
- Division of Pediatric Neurology, Department of Pediatrics, University of Alberta, 11405-87 Avenue, 4th Floor, Edmonton, AB T6G-1C9 Canada
| | - Blair Seifert
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Department of Pharmaceutical Services, Saskatchewan Health Authority, Saskatoon Health Region, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N-0W8 Canada
| | - Andrew W. Lyon
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, St. Paul’s Hospital, 1702 20th Street West, Saskatoon, SK S7M-0Z9 Canada
| | - Jane Alcorn
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Room E3210 Health Sciences 104 Clinic Place, Saskatoon, SK S7N-2Z4 Canada
| | - Bryan Acton
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Saskatchewan Health Authority and Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Department of Clinical Health Psychology, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8 Canada
| | - Scott Corley
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Clinical Trial Support Unit, University of Saskatchewan, Royal University Hospital, Room 5676, 103 Hospital Drive, Saskatoon, SK S7N 0W8 Canada
| | - Erin Prosser-Loose
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Department of Pediatrics, University of Saskatchewan, Royal University Hospital, Room 2665, 103 Hospital Drive, Saskatoon, SK S7N 0W8 Canada
| | - Darrell D. Mousseau
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Cell Signalling Laboratory, Departments of Psychiatry and Physiology, University of Saskatchewan, GB41, HSB 107 Wiggins Ave, Saskatoon, SK S7N 5E5 Canada
| | - Hyun J. Lim
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Department of Community Health and Epidemiology, University of Saskatchewan, Room E3222 Health Sciences, 104 Clinic Place, Saskatoon, SK S7N-2Z4 Canada
| | - Jose Tellez-Zenteno
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Department of Medicine, Division of Neurology, University of Saskatchewan, Royal University Hospital, Room 1622, 103 Hospital Drive, Saskatoon, SK S7N 0W8 Canada
| | - Linda Huh
- Division of Pediatric Neurology, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Room 2D19, 4480 Oak Street, Vancouver, BC V6H-3V4 Canada
| | - Edward Leung
- Division of Pediatric Neurology, Room CE208, Department of Pediatrics 5, University of Manitoba, Children’s Hospital, 840 Sherbrooke Street, Winnipeg, MB R3A-1S1 Canada
| | - Lionel Carmant
- Division of Pediatric Neurology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Universite de Montreal, Room 5-4, 3175 Chemin de la Cote Ste-Catherine, Montreal, QC H3T-1C5 Canada
| | - Richard J. Huntsman
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan Canada
- Department of Pediatrics, Royal University Hospital, Rm 2744, 103 Hospital Drive, Saskatoon, SK S7N 0W8 Canada
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Impact of resective epilepsy surgery on health-related quality of life in children with and without low intellectual ability. Epilepsy Behav 2018; 83:131-136. [PMID: 29705622 DOI: 10.1016/j.yebeh.2018.03.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The current study examined pre- and postoperative health-related quality of life (HRQL) across children with and without low intellectual ability. We also aimed to clarify the literature on postsurgical change by assessing domain-specific HRQL pre- and postoperatively in children with drug-resistant epilepsy. METHOD All patients (n=111) underwent resective epilepsy surgery between 1996 and 2016 at the Hospital for Sick Children in Toronto, comparing baseline and 1-year follow-up HRQL with the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-76). At the group-level, postsurgical change in HRQL was examined through linear mixed-effects modeling. Clinically important change in HRQL at the individual level was quantified using a standard error of measurement (SEM)-based criterion, and estimates were stratified by intellectual ability. RESULTS Children with epilepsy and low intellectual ability had lower overall HRQL compared with those with normal intelligence (b=-10.45, SE=4.89, p=.035). No differences in change in HRQL related to intellectual level were found. In the broader sample, significant postoperative improvements were found for HRQL related to physical activity (b=8.28, SE=1.79, p<.001), social activity (b=15.81, SE=2.76, p<.001), and behavior (b=4.34, SE=1.35, p=.001). Postoperative improvements in physical and social HRQL were associated with better seizure control (p=.011). Conversely, cognitive and emotional domains of HRQL did not improve one year postoperatively, even in the presence of improved seizure control. SIGNIFICANCE Results suggest that children with low intellectual ability can expect to achieve similar improvements in HRQL after epilepsy surgery compared with those with normal intelligence. Further, while overall HRQL is shown to improve in children following epilepsy surgery, domain-specific change is nuanced and has important implications for health practitioners aiming to monitor treatment progress of patients.
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20
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Rosenberg EC, Louik J, Conway E, Devinsky O, Friedman D. Quality of Life in Childhood Epilepsy in pediatric patients enrolled in a prospective, open-label clinical study with cannabidiol. Epilepsia 2017; 58:e96-e100. [PMID: 28617940 PMCID: PMC5568670 DOI: 10.1111/epi.13815] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/29/2022]
Abstract
Recent clinical trials indicate that cannabidiol (CBD) may reduce seizure frequency in pediatric patients with certain forms of treatment-resistant epilepsy. Many of these patients experience significant impairments in quality of life (QOL) in physical, mental, and social dimensions of health. In this study, we measured the caregiver-reported Quality of Life in Childhood Epilepsy (QOLCE) in a subset of patients enrolled in a prospective, open-label clinical study of CBD. Results from caregivers of 48 patients indicated an 8.2 ± 9.9-point improvement in overall patient QOLCE (p < 0.001) following 12 weeks of CBD. Subscores with improvement included energy/fatigue, memory, control/helplessness, other cognitive functions, social interactions, behavior, and global QOL. These differences were not correlated to changes in seizure frequency or adverse events. The results suggest that CBD may have beneficial effects on patient QOL, distinct from its seizure-reducing effects; however, further studies in placebo-controlled, double-blind trials are necessary to confirm this finding.
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Affiliation(s)
- Evan C. Rosenberg
- Department of Neuroscience and Physiology, New York University Langone, Medical Center, New York, NY, 10016
| | - Jay Louik
- Comprehensive Epilepsy Center, New York University Langone, Medical Center, New York, NY, 10016
| | - Erin Conway
- Comprehensive Epilepsy Center, New York University Langone, Medical Center, New York, NY, 10016
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, New York University Langone, Medical Center, New York, NY, 10016
| | - Daniel Friedman
- Comprehensive Epilepsy Center, New York University Langone, Medical Center, New York, NY, 10016
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Abstract
First-line treatment for epilepsy is antiepileptic drug and requires an interdisciplinary approach and enduring commitment and adherence from the patient and family for successful outcome. Despite adherence to antiepileptic drugs, refractory epilepsy occurs in approximately 30% of children with epilepsy, and surgical treatment is an important intervention to consider. Surgical management of pediatric epilepsy is highly effective in selected patients with refractory epilepsy; however, an evidence-based protocol, including best methods of presurgical imaging assessments, and neurodevelopmental and/or behavioral health assessments, is not currently available for clinicians. Surgical treatment of epilepsy can be critical to avoid negative outcomes in functional, cognitive, and behavioral health status. Furthermore, it is often the only method to achieve seizure freedom in refractory epilepsy. Although a large literature base can be found for adults with refractory epilepsy undergoing surgical treatment, less is known about how surgical management affects outcomes in children with epilepsy. The purpose of the review was fourfold: (1) to evaluate the available literature regarding presurgical assessment and postsurgical outcomes in children with medically refractory epilepsy, (2) to identify gaps in our knowledge of surgical treatment and its outcomes in children with epilepsy, (3) to pose questions for further research, and (4) to advocate for a more unified presurgical evaluation protocol including earlier referral for surgical candidacy of pediatric patients with refractory epilepsy. Despite its effectiveness, epilepsy surgery remains an underutilized but evidence-based approach that could lead to positive short- and long-term outcomes for children with refractory epilepsy.
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Abstract
The goal of this study was to evaluate how epilepsy affected the health-related quality of life (HRQOL) in children with epilepsy, as well as the risk factors for poor HRQOL. Parents of epileptic children (n = 223) and parents of healthy children (n = 216) were enrolled. The Child Epilepsy Questionnaire-Parental form was given to all parents. Children with epilepsy had significantly lower HRQOL scores for overall QOL and all subscales. Seizure types were not associated with HRQOL, but the age of the child with epilepsy, disease courses and seizure frequency did influence the quality of life. Epilepsy has a severe impact on children's HRQOL, and age, increased seizure frequency and longer duration of epilepsy are associated with poor HRQOL.
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Affiliation(s)
- Xinjie Liu
- Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Qizheng Han
- Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
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Verification of the reliability and validity of a Japanese version of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-J). Brain Dev 2015; 37:933-42. [PMID: 25956393 DOI: 10.1016/j.braindev.2015.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/23/2015] [Accepted: 04/08/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE A Japanese version of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-J) was developed using international guidelines as a QOL scale for childhood epilepsy; its reliability and validity were examined, focusing on Japanese pediatric epilepsy patients applicability. METHODS A pilot test questionnaire survey was conducted; involving parents of pediatric epilepsy patients aged 4-15 undergoing outpatient treatment. 278 responses were obtained and analyzed. RESULTS Internal consistency for the 16 QOLCE-J subscales, except for <depression>, was sufficient, and a high overall coefficient α was obtained. The intraclass correlation coefficient was also high, supporting the test-retest reliability of this version. Associations among the subscales, high correlations of r>0.7 were observed among <attention/concentration>, <memory>, and <language>, representing cognitive and behavioral aspects, and among these and <behavior>. In contrast, correlations among others were moderate or weaker. Furthermore, correlations of r>0.35 were observed among the subscales of the SDQ (Strength and Difficulties Questionnaire) used as an external criterion and the QOLCE-J, confirming the criterion validity of the study version. Analysis of associations between the total QOLCE-J score and pathology of epilepsy, found significant correlation with age of onset and frequency of seizures, ADL, and antiepileptics side effects' symptoms. QOLCE has mostly been used in treatment resistant pediatric patients, the influence of interictal period presently observed, like antiepileptic side effects' symptoms; suggest usefulness for pediatric patients with seizures under control. CONCLUSIONS The QOLCE-J with sufficient reliability and validity may be applicable as a QOL scale for Japanese children with epilepsy.
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Downes M, Greenaway R, Clark M, Helen Cross J, Jolleff N, Harkness W, Kaliakatsos M, Boyd S, White S, Neville BGR. Outcome following multiple subpial transection in Landau-Kleffner syndrome and related regression. Epilepsia 2015; 56:1760-6. [DOI: 10.1111/epi.13132] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rebecca Greenaway
- UCL Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - Maria Clark
- UCL Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - J. Helen Cross
- UCL Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | | | - William Harkness
- UCL Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - Marios Kaliakatsos
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - Stewart Boyd
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - Steve White
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
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25
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Goodwin SW, Lambrinos AI, Ferro MA, Sabaz M, Speechley KN. Development and assessment of a shortened Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55). Epilepsia 2015; 56:864-72. [PMID: 25912151 DOI: 10.1111/epi.13000] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and validate a shortened version of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). A secondary aim was to compare baseline risk factors predicting health-related quality of life (HRQoL) in children newly diagnosed with epilepsy, as identified using the original and shortened version. METHODS Data came from the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES, N = 373), a multicenter prospective cohort study. Principal component analysis reduced the number of items from the original QOLCE, and factor analysis was used to assess the factor structure of the shortened version. Convergent and divergent validity was assessed by correlating the Child Health Questionnaire (CHQ) with the shortened QOLCE. Multiple regression identified risk factors at diagnosis for HRQoL at 24 months. RESULTS A four-factor, higher-order, 55-item solution was obtained. A total of 21 items were removed. The final model represents functioning in four dimensions of HRQoL: Cognitive, Emotional, Social, and Physical. The shortened QOLCE demonstrated acceptable fit: Bentler's Comparative Fit Index = 0.944; Tucker-Lewis Index = 0.942; root mean square approximation = 0.058 (90% CI: 0.056-0.061); weighted root mean square residuals (WRMR) = 1.582, and excellent internal consistency (α = 0.96, subscales α > 0.80). Factor loadings were good (first-order: λ = 0.66-0.93; higher-order λ = 0.66-0.85; p < 0.001 for all). The shortened QOLCE scores correlated strongly with similar subscales of the Child Health Questionnaire (ρ = 0.38-0.70) while correlating weakly with dissimilar subscales (ρ = 0.30-0.31). While controlling for HRQoL at diagnosis, predictors for better HRQoL at 24 months were the following: no cognitive problems reported (p = 0.001), better family functioning (p = 0.014), fewer family demands (p = 0.008), with an interaction between baseline HRQoL and cognitive problems (p = 0.011). SIGNIFICANCE Results offer initial evidence regarding reliability and validity of the proposed 55-item shortened version of the QOLCE (QOLCE-55). The QOLCE-55 produced results on risk factors consistent with those found using the original measure. Given the fewer items, QOLCE-55 may be a viable option reducing respondent burden when assessing HRQoL in children with epilepsy.
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Affiliation(s)
- Shane W Goodwin
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Anastasia I Lambrinos
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Mark A Ferro
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Sabaz
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kathy N Speechley
- Department of Epidemiology & 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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Elliott JO, Richardson VE. The biopsychosocial model and quality of life in persons with active epilepsy. Epilepsy Behav 2014; 41:55-65. [PMID: 25305434 DOI: 10.1016/j.yebeh.2014.09.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite a long recognized need in the field of the importance of the psychological and social factors in persons with epilepsy (PWE), the medical community has continued to focus primarily on seizures and their treatment (the biological-biomedical model). From the biopsychosocial perspective, a person's lived experience needs to be incorporated into the understanding of quality of life. While the biopsychosocial model has gained prominence over the years, it has not been studied much in epilepsy. METHODS The study sample included 1720 PWE from the 2003 and the 2005 Canadian Community Health Survey (CCHS). Data were analyzed using set correlation, as it allows for the examination of the relative contribution of sets of independent variables (biological, psychological, and social domains) and a set of dependent variables (quality of life) of interest, defined as self-rated health status, self-rated mental health status, and life satisfaction. RESULTS Results provide strong evidence that the full biopsychosocial model explained a significantly larger amount of variance in quality of life (R(2) = 55.0%) compared with the biological-biomedical model alone (R(2) = 24.8%). When the individual domains of the biopsychosocial model were controlled for, the psychological (R(2) = 24.6%) and social (R(2) = 18.5%) domains still explained a greater amount of the variance in quality of life compared with the biological-biomedical model (R(2) = 14.3%). CONCLUSIONS While seizure freedom will continue to be an important treatment goal in epilepsy, the psychological and social domains are an important consideration for both interventional programs and clinical research designed to improve quality of life in PWE. Better integration of social workers and psychologists into routine care may help address these disparities.
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Affiliation(s)
- John O Elliott
- OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA; The Ohio State University, College of Social Work, Stillman Hall, 1947 College Road, Columbus, OH 43210, USA.
| | - Virginia E Richardson
- The Ohio State University, College of Social Work, Stillman Hall, 1947 College Road, Columbus, OH 43210, USA.
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Developing the Pediatric Refractory Epilepsy Questionnaire: a pilot study. Epilepsy Behav 2014; 37:26-31. [PMID: 24967697 DOI: 10.1016/j.yebeh.2014.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE Up to 14% of children with epilepsy continue to experience seizures despite having appropriate medical therapy and develop medically refractory epilepsy (MRE). Assessing clinical outcomes and therapeutic efficacy in children with MRE undergoing palliative epilepsy surgery has been challenging because of the lack of a quantitative instrument capable of estimating the clinical status of these patients. The ideal instrument would at once consider seizure control, neurodevelopment, caregiver burden, and quality of life. The purpose of this study was to develop and pilot the Pediatric Refractory Epilepsy Questionnaire (PREQ), a quantitative instrument to assess the severity and individual burden of epilepsy in children with MRE undergoing palliative epilepsy treatments. METHODS The caregivers of 25 patients with MRE completed the PREQ and the Quality of Life in Childhood Epilepsy (QOLCE) measure and participated in a semistructured interview. Medical records of the patients were reviewed, an Early Childhood Epilepsy Severity Scale (E-CHESS) score was calculated, and a Global Assessment of Severity of Epilepsy (GASE) score was obtained for each patient. KEY FINDINGS The initial PREQ was modified based on the analysis of responses, association with previously validated scales, comments from caregivers, and expertise of the PREQ panelists. Pediatric Refractory Epilepsy Questionnaire subscale scores were calculated based on clinical paradigm and compared with independent measures of seizure severity and quality of life. Significant correlations were observed between the seizure severity subscale and the GASE score (r=0.55) and between the mood subscale and the well-being score (r=0.61) on the QOLCE. Significant correlations were also observed between the caregiver rating of seizure severity and the GASE score (r=0.53), the social activity score (r=0.57), and the behavior score (r=0.43) on the QOLCE. Correlations between the caregiver rating of quality of life and the quality of life score (r=0.58) and the number of AEDs used (r=0.45) were also significant. SIGNIFICANCE This pilot study is an initial, critical step in the development of the PREQ. The significant correlations between the PREQ subscales and the external epilepsy severity and quality of life measures lend preliminary support to our hypothesis that the PREQ is assessing the severity of epilepsy along with other important domains, such as mood, neurodevelopment, and quality of life. A larger prospective study of this modified PREQ is currently underway to further develop the PREQ.
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Lee YJ, Lee JS, Kang HC, Kim DS, Shim KW, Eom S, Kim HD. Outcomes of epilepsy surgery in childhood-onset epileptic encephalopathy. Brain Dev 2014; 36:496-504. [PMID: 23850002 DOI: 10.1016/j.braindev.2013.06.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE to evaluate the outcomes and role of epilepsy surgery in children with intractable epileptic encephalopathy (EE). METHODS ninety-five children (64 boys, 31 girls) with intractable EE were treated by epilepsy surgery at Severance Children's Hospital from 2003 to 2008. Surgical treatments included lobar resection, hemispherotomy and corpus callosotomy (CC). Seventy-six children were Lennox-Gastaut syndrome (LGS), and 19 had West syndrome. RESULTS of the 76 patients with LGS, CC was performed in 37 patients (48.7%), lobar resection in 29 (38.2%) and hemispherotomy in 10 (13.2%). Of the 19 patients with West syndrome, respective surgery was performed in 15 patients (78.9%) and CC in 4 (21.1%). Of the patients receiving respective surgery, Engel's class I outcomes were achieved for 24 of 39 (61.5%) of LGS patients, and for 9 of 15 (60.0%) of West syndrome. Malformations of cortical development were commonly observed, appearing in 73.5% (36/49). In neuropsychiatric tests, 19 of 27 with LGS demonstrated improvement in postoperative cognitive function. More significant intellectual improvement correlated well with shorter epilepsy duration, good seizure outcomes, and decreased number of antiepileptic drugs. CONCLUSIONS epilepsy surgery should be considered in treating childhood intractable EE with expectation of improvement of both seizure and cognitive outcomes, even in cases of LGS.
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Affiliation(s)
- Yun-Jin Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Republic of Korea
| | - Joon Soo Lee
- Department of Pediatrics, Pediatric Epilepsy Clinics, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, Republic of Korea
| | - Hoon-Chul Kang
- Department of Pediatrics, Pediatric Epilepsy Clinics, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, Republic of Korea
| | - Dong-Seok Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Kyu-Won Shim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Soyong Eom
- Department of Psychiatrics, Severance Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Heung Dong Kim
- Department of Pediatrics, Pediatric Epilepsy Clinics, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, Republic of Korea.
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Park SY, Kwon HE, Kang HC, Lee JS, Kim DS, Kim HD. Epilepsy surgery in pediatric intractable epilepsy with destructive encephalopathy. J Epilepsy Res 2013; 3:48-53. [PMID: 24649473 PMCID: PMC3952248 DOI: 10.14581/jer.13010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/05/2013] [Indexed: 11/03/2022] Open
Abstract
Background and Purpose: The aim of the current study is to review the clinical features, surgery outcomes and parental satisfaction of children with destructive encephalopathy who underwent epilepsy surgery due to medically intractable seizures. Methods: 48 patients who underwent epilepsy surgery from October 2003 to August 2011 at Severance Children’s Hospital have been reviewed. The survey was conducted for functional outcomes and parental satisfaction at least 1 year after the surgery. Results: Epileptic encephalopathy including Lennox-Gastaut syndrome and infantile spasms was more prevalent than symptomatic focal epilepsy. Hypoxic ischemic injury accounted for most of the underlying etiology of the destructive encephalpathy, followed by central nervous system infection and head trauma. 27 patients (56.3%) underwent resective surgery and 21 patients (43.7%) underwent palliative surgery. 16 patients (33.3%) achieved seizure free and 27 parents (87.5%) reported satisfaction with the outcome of their children’s epilepsy surgery. In addition, 14 parents (77.8 %) whose children were not seizure free reported satisfaction with their children’s improvement in cognitive and behavior issues. Conclusions: Epilepsy surgery in destructive encephalopathy was effective for controlling seizures. Parents reported satisfaction not only with the surgical outcomes, but also with improvement of cognitive and behavior issues.
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Affiliation(s)
- So Young Park
- Department of Pediatric Neurology, Pediatric Epilepsy Clinics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine
| | - Hye Eun Kwon
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Hoon-Chul Kang
- Department of Pediatric Neurology, Pediatric Epilepsy Clinics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine
| | - Joon Soo Lee
- Department of Pediatric Neurology, Pediatric Epilepsy Clinics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine
| | - Dong Seok Kim
- Division of Pediatric Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Department of Pediatric Neurology, Pediatric Epilepsy Clinics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine
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Perry MS, Duchowny M. Surgical versus medical treatment for refractory epilepsy: Outcomes beyond seizure control. Epilepsia 2013; 54:2060-70. [DOI: 10.1111/epi.12427] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M. Scott Perry
- Comprehensive Epilepsy Program; Jane and John Justin Neuroscience Center; Cook Children's Medical Center; Fort Worth Texas U.S.A
| | - Michael Duchowny
- Department of Neurology and Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
- Department of Neurology; University of Miami Leonard Miller School of Medicine; Miami Florida U.S.A
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Health-related quality of life before and after pediatric epilepsy surgery: the influence of seizure outcome on changes in physical functioning and social functioning. Epilepsy Behav 2013; 27:477-83. [PMID: 23631952 DOI: 10.1016/j.yebeh.2013.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/06/2013] [Accepted: 03/08/2013] [Indexed: 11/21/2022]
Abstract
Health-related quality of life (HRQOL) is an important outcome in pediatric epilepsy surgery, but there are few studies that utilize presurgical ratings to assess the effect of surgery on HRQOL. We collected parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 28 children who participated in neuropsychological assessment before and after epilepsy surgery. Our results revealed significant improvements in overall HRQOL after surgery, especially in physical and social activities. These changes were apparent despite generally unchanged intellectual and psychological functioning. Children with better seizure outcome had more improvement in HRQOL; however, improvements were not statistically different among children with Engel class I, II, and III outcomes. Our results suggest that children can experience significant improvements in HRQOL following epilepsy surgery even when neuropsychological functioning remains unchanged. Moreover, improvements in HRQOL appear evident in children who experience any worthwhile improvement in seizure control (Engel class III or better).
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Kayyali HR, Abdelmoity A, Baeesa S. The role of epilepsy surgery in the treatment of childhood epileptic encephalopathy. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:983049. [PMID: 23691295 PMCID: PMC3652151 DOI: 10.1155/2013/983049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/25/2013] [Accepted: 03/29/2013] [Indexed: 11/23/2022]
Abstract
Children with epileptic encephalopathy often have global impairment of brain function and frequent intractable seizures, which contribute further to their developmental disability. Many of these children have identifiable brain lesion on neurological imaging. In such cases, epilepsy surgery may be considered as a treatment option despite the lack of localized epileptic pattern on electroencephalogram (EEG). In this paper, we summarize the clinical features of epileptic encephalopathy syndromes and review the reported literature on the surgical approach to some of these disorders.
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Affiliation(s)
- Husam R. Kayyali
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah 21499, Saudi Arabia
| | - Ahmed Abdelmoity
- Department of Neurology, Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA
| | - Saleh Baeesa
- Division of Neurosurgery, College of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Division of Neurological Surgery, King Abdulaziz University Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia
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Fattal-Valevski A, Nissan N, Kramer U, Constantini S. Seizures as the clinical presenting symptom in children with brain tumors. J Child Neurol 2013; 28:292-6. [PMID: 22628219 DOI: 10.1177/0883073812445786] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study summarizes our clinical and surgical experience with pediatric brain tumors that were initially presented with seizures. The records of 367 consecutive children, treated for brain tumors between the years 1996 and 2007, were retrospectively analyzed, focusing on the clinical manifestations, diagnostic gap, and postoperative seizure follow-up that lasted at least 2 years. Seizures, mainly focal, were the clinical manifestation of brain tumor in 57 of 367 children. Normal neurologic examination and electroencephalography (EEG) were in 77.8% and 37.5%, respectively. Diagnostic gap correlated with low-grade and temporal lobe tumors. Postoperative follow-up revealed freedom of seizure in 77.6%. Favorable seizure outcome correlated with low preoperative seizures frequency, preoperative response to antiepileptic drugs, and hemispheric tumor location. We conclude that response to antiepileptic drugs, generalized seizures, normal EEG, and normal neurologic examination should not exclude tumor etiology. Moreover, broader indications for imaging should be employed while evaluating a child with a seizure.
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Park C, Wethe JV, Kerrigan JF. Decreased quality of life in children with hypothalamic hamartoma and treatment-resistant epilepsy. J Child Neurol 2013; 28:50-5. [PMID: 22496118 DOI: 10.1177/0883073812439622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated health-related quality of life in patients with hypothalamic hamartoma, to see how it differs from that of children with more common neurologic disorders. We used the PedsQL 4.0, along with the Child Behavior Checklist, Hague Seizure Severity Scale, and Side Effects Scale, to evaluate presurgical patients with hypothalamic hamartoma and epilepsy (n = 21). The results were compared with those of age-matched cohorts with migraine (n = 19) and Benign Epilepsy with Central Temporal Spikes (n = 11). In comparison with the migraine group, the patients with hypothalamic hamartoma had decreased health-related quality of life across all domains of the PedsQL 4.0. Compared with the benign epilepsy group, the hypothalamic hamartoma cohort has a significantly lower score in School Function. Comorbid psychomotor retardation was predictive of lower quality of life. Research examining the efficacy of recently developed surgical treatments for hypothalamic hamartoma should include health-related quality of life as an outcome measure.
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Affiliation(s)
- Cleo Park
- Division of Pediatric Neurology and Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix Children's Hospital, Phoenix, AZ, USA.
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Long-term outcomes of epilepsy surgery in school-aged children with partial epilepsy. Pediatr Neurol 2012; 47:284-90. [PMID: 22964443 DOI: 10.1016/j.pediatrneurol.2012.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/20/2012] [Indexed: 11/24/2022]
Abstract
The pediatric epileptic spectrum and seizure control in surgical patients have been defined in developed countries. However, corresponding data on school-aged children from developing countries are insufficient. We summarized epileptic surgical data from four centers in China, to compare surgical outcomes of school-aged children with intractable partial epilepsy from China and those from developed countries, and introduce surgical candidate criteria. Data from 206 children (aged 6-14 years) undergoing surgical resection for epilepsy between September 2001 and January 2007 were selected. Postoperative freedom from seizures was achieved in 173 cases (84.0%) at 1 year, 149 (72.3%) at 3 years, and 139 (67.5%) at 5 years. Patients with focal magnetic resonance imaging abnormalities and a short history of seizure were most likely to become seizure-free postoperatively. Those with preoperative low intelligence quotients who became seizure-free postoperatively achieved improvements in full memory quotients, intelligence quotients, and overall quality of life at 2 years. Significant differences were evident in mean changes of full intelligence quotient, full memory quotient, and overall quality of life between patients with preoperative low intelligence quotients who received corpus callosotomies and those with a normal preoperative intelligence quotient, and between seizure-free children and those with continual seizures.
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Speechley KN, Ferro MA, Camfield CS, Huang W, Levin SD, Smith ML, Wiebe S, Zou G. Quality of life in children with new-onset epilepsy: a 2-year prospective cohort study. Neurology 2012; 79:1548-55. [PMID: 23019268 DOI: 10.1212/wnl.0b013e31826e25aa] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess health-related quality of life (HRQL) over 2 years in children 4-12 years old with new-onset epilepsy and risk factors. METHODS Data are from a multicenter prospective cohort study, the Health-Related Quality of Life Study in Children with Epilepsy Study (HERQULES). Parents reported on children's HRQL and family factors and neurologists on clinical characteristics 4 times. Mean subscale and summary scores were computed for HRQL. Individual growth curve models identified trajectories of change in HRQL scores. Multiple regression identified baseline risk factors for HRQL 2 years later. RESULTS A total of 374 (82) questionnaires were returned postdiagnosis and 283 (62%) of eligible parents completed all 4. Growth rates for HRQL summary scores were most rapid during the first 6 months and then stabilized. About one-half experienced clinically meaningful improvements in HRQL, one-third maintained their same level, and one-fifth declined. Compared with the general population, at 2 years our sample scored significantly lower on one-third of CHQ subscales and the psychosocial summary. After controlling for baseline HRQL, cognitive problems, poor family functioning, and high family demands were risk factors for poor HRQL 2 years later. CONCLUSIONS On average, HRQL was relatively good but with highly variable individual trajectories. At least one-half did not experience clinically meaningful improvements or declined over 2 years. Cognitive problems were the strongest risk factor for compromised HRQL 2 years after diagnosis and may be largely responsible for declines in the HRQL of children newly diagnosed with epilepsy.
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Elliott I, Kadis DS, Lach L, Olds J, McCleary L, Whiting S, Snyder T, Smith ML. Quality of life in young adults who underwent resective surgery for epilepsy in childhood. Epilepsia 2012; 53:1577-86. [PMID: 22812675 DOI: 10.1111/j.1528-1167.2012.03594.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study investigated quality of life (QOL) in young adults who had undergone epilepsy surgery before the age of 16 years. The contribution to QOL of seizure status in the prior year, sex, number of antiepileptic drugs, and mood were evaluated. METHODS Sixty-nine young adults who had undergone surgery were subdivided into those who were seizure-free in the past year (n = 38) and those who had seizures (n = 31) in that time. A nonsurgical comparison group of young adults (n = 29) with childhood-onset medically intractable epilepsy was also studied. All groups completed measures of QOL and mood. KEY FINDINGS After accounting for mood, sex, and number of antiepileptic drugs, the seizure-free group reported better cognitive and physical function and overall QOL, experienced less seizure worry, and had better self-perception. Mood was the most consistently predictive covariate, and was independently predictive of many aspects of QOL. SIGNIFICANCE Seizure freedom associated with surgery in childhood is associated with improved QOL in certain domains. Findings highlight the importance of mood in determining self-perception of QOL.
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Affiliation(s)
- Irene Elliott
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Ciliberto MA, Limbrick D, Powers A, Titus JB, Munro R, Smyth MD. Palliative hemispherotomy in children with bilateral seizure onset. J Neurosurg Pediatr 2012; 9:381-8. [PMID: 22462702 DOI: 10.3171/2011.12.peds11334] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intractable epilepsy is a significant burden on families and on the cognitive development and quality of life (QOL) of patients. Periinsular hemispherotomy (PIH) for medically intractable epilepsy can benefit patients who qualify for this procedure. The ideal hemispherotomy candidate has ipsilateral ictal and interictal epileptiform activity, unilateral MR imaging abnormalities, contralateral hemiplegia, and a normal contralateral hemisphere. However, certain patients present with a mixed picture of bilateral electroencephalography (EEG) findings and severe intractable epilepsy, prompting consideration of a more aggressive treatment approach. This report introduces the possibility of surgery for patients who normally would not meet criteria for this treatment modality. METHODS In this retrospective chart review, the authors report on 7 patients with bilateral seizure onset noted on routine or video-EEG monitoring. A QOL phone questionnaire, based on the Quality of Life in Childhood Epilepsy tool, was administered to a parent. The authors reviewed each patient's chart for surgical complications, changes in examination, QOL, limited neuropsychological outcomes, and seizure outcomes. They also investigated each chart for MR imaging and EEG findings as well as the patient's epilepsy clinic notes for seizure semiology and frequency. RESULTS All patients enjoyed a decrease in seizure frequency and a subjective increase in QOL after PIH. Five patients (71%) achieved Engel Class I or II seizure control. The mean follow-up was 3.64 years (2-5.3 years). One patient is now off all antiseizure medication. No patient had a decrement in Full Scale IQ on postsurgical testing, and 2 (28.5%) of 7 individuals had increased adaptive and social functioning. Postsurgical examination changes included hemiplegia and homonymous hemianopia. CONCLUSIONS Hemispherotomy in patients with intractable epilepsy is generally reserved for individuals with unilateral epileptiform abnormalities or lesions on MR imaging. Seven patients in this study benefited from surgery despite bilateral seizure onset with improvement in seizure control and overall QOL. Thus, bilateral ictal onset does not necessarily preclude consideration for hemispherotomy in selected patients with severe medically refractory epilepsy.
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Affiliation(s)
- Michael Anthony Ciliberto
- Departments of Developmental and Pediatric Neurology, Washington University, St. Louis, MO 63110, USA.
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Seizure recency and quality of life in adolescents with childhood-onset epilepsy. Epilepsy Behav 2012; 23:47-51. [PMID: 22134098 PMCID: PMC3261362 DOI: 10.1016/j.yebeh.2011.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/10/2011] [Indexed: 11/21/2022]
Abstract
Health-related quality of life (HRQOL) is associated with seizure recency among adults with epilepsy. In a prospective, community-based study of long-term outcomes of childhood-onset epilepsy, we evaluated whether worse HRQOL is associated with more recent seizures among children and adolescents with epilepsy. We used the Child Health Questionnaire (CHQ), a generic measure with child and parent-proxy versions, to measure HRQOL. Among 277 children with epilepsy (CWE) assessed 9 years after diagnosis, parent-proxy reported but not child self-reported HRQOL was significantly worse for those having seizures in the prior year than for those who were seizure free ≥1 year across the majority of scales. There were no differences between CWE in remission for 1-5 years and those seizure free ≥5 years for child and parent-proxy reported HRQOL with the exception of the parent Emotional Impact scale, suggesting that HRQOL differences related to seizure recency level off after the initial year of remission.
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Liava A. Internalizing disorders and psychosocial functioning in the context of successful epilepsy surgery in children: implications for a comprehensive approach and a global perspective of treatment. Epilepsy Behav 2011; 22:815-7. [PMID: 22036466 DOI: 10.1016/j.yebeh.2011.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 09/24/2011] [Indexed: 10/15/2022]
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Duchowny M. Comment to the paper: palliative functional hemispherectomy for treatment of refractory status epilepticus associated with Alpers' disease. Childs Nerv Syst 2011; 27:1327-8. [PMID: 21667152 DOI: 10.1007/s00381-011-1501-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 05/18/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Performing epilepsy surgery in a child with a neurodegenerative illness is a relatively unexplored challenge. In this issue of CNS, Lupashko and coauthors report the use of epilepsy surgery to eliminate seizures without influencing the underlying progressive disorder. METHOD Functional hemispherectomy was performed in a 4-year-old girl with seizures caused by Alpers' disease. RESULTS Seizure freedom and an improved quality of life were achieved briefly despite deteriorating neurologic status. CONCLUSION Further studies will be needed to confirm the positive benefits of palliative epilepsy surgery in children with progressive neurologic illnesses.
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Affiliation(s)
- Michael Duchowny
- Neurology Training and the Comprehensive Epilepsy Center, Miami Children's Hospital, Miami, FL, USA.
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Terra VC, Cysneiros RM, Schwartzman JS, Teixeira MCTV, Arida RM, Cavalheiro EA, Scorza FA, de Albuquerque M. Mothers of children with cerebral palsy with or without epilepsy: a quality of life perspective. Disabil Rehabil 2011; 33:384-8. [DOI: 10.3109/09638281003611052] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Malphrus AD, Wilfong AA. Use of the newer antiepileptic drugs in pediatric epilepsies. Curr Treat Options Neurol 2011; 9:256-67. [PMID: 17580006 DOI: 10.1007/s11940-007-0012-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children with epilepsy, particularly infants, differ from adults not only in the clinical manifestations of their seizures but also in the presence of unique electroencephalographic patterns, etiologies, and response to antiepileptic drugs (AEDs). There is a growing list of newer AEDs and nonpharmacologic therapies available to manage childhood epilepsy. These newer AEDs may not be overall more efficacious than the older drugs, but they do appear to be safer, better tolerated, and to have fewer drug-drug interactions. Selection of the AED for initial therapy must be based upon clinical judgment and patient-specific circumstances, such as the specific epilepsy syndrome being treated, anticipated duration of treatment, presence of comorbidities, ability to use certain formulations, and overall cost effectiveness. In some cases, seizures may be aggravated by the use of certain AEDs. Overall, oxcarbazepine is the first-line treatment for localization-related epilepsy with partial-onset seizures. For generalized epilepsies, the AED choice is highly dependent upon which specific syndrome is being treated. For generalized epilepsies with primarily absence seizures, lamotrigine is the AED of first choice. For mixed generalized epilepsies such as Lennox-Gastaut syndrome or juvenile myoclonic epilepsy, zonisamide or topiramate are the first-line agents. For infants with West syndrome, treatment is based upon the underlying etiology: vigabatrin for tuberous sclerosis; adrenocorticotropic hormone for children with no specific etiology uncovered (cryptogenic); and zonisamide for those with a severe symptomatic etiology other than tuberous sclerosis. Single drug therapy (monotherapy) is the goal of epilepsy treatment because this is associated with better compliance, fewer adverse effects, and lower cost. If the seizures prove intractable or adverse effects are encountered with the first AED, then a second monotherapy trial is undertaken. Once three appropriate medications at therapeutic doses have failed, other modalities should be considered, including epilepsy surgery, vagus nerve stimulation, and the ketogenic diet.
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Affiliation(s)
- Amy D Malphrus
- Angus A. Wilfong, MD Baylor College of Medicine, 6621 Fannin Street, CC1250, Houston, TX 77030, USA.
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Skirrow C, Cross JH, Cormack F, Harkness W, Vargha-Khadem F, Baldeweg T. Long-term intellectual outcome after temporal lobe surgery in childhood. Neurology 2011; 76:1330-7. [PMID: 21482948 DOI: 10.1212/wnl.0b013e31821527f0] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Temporal lobe resection is an established treatment for medication-resistant temporal lobe epilepsy, which in recent years has increasingly been performed in children. However, little is known about the long-term outcome in these children. The aim of this study was to characterize intellectual and psychosocial functioning of children after temporal lobe resection as they progress into late adolescence and adulthood. METHODS We report the long-term follow-up of 42 children who underwent temporal lobe surgery after an average postoperative period of 9 years. Longitudinal change in IQ was documented, psychosocial outcome including quality of life was assessed, and preoperative and postoperative T1-weighted MRI brain scans were evaluated quantitatively. A well-matched nonsurgical comparison group of 11 children with similar clinical characteristics was also assessed. RESULTS At follow-up, 86% of the surgical group were seizure-free, and 57% were no longer taking antiepileptic medication. A significant increase in IQ was found in the surgical group after an extended follow-up period of >5 years. This IQ change was not found in the nonsurgical comparison group. IQ increases were associated with cessation of antiepileptic medication and changes in MRI-derived gray matter volume. The surgical group also reported better psychosocial outcome including quality of life, which was more strongly associated with seizure freedom rather than surgery per se. CONCLUSIONS Surgery for temporal lobe epilepsy performed in childhood results in excellent long-term seizure control and favorable cognitive outcome along with positive effects on brain development. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that temporal lobectomy in children with temporal lobe epilepsy is associated with improved long-term intellectual outcomes compared with those undergoing standard medical treatment.
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Affiliation(s)
- C Skirrow
- Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College London, London WC1N 1EH, UK
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Roth J, Olasunkanmi A, MacAllister WS, Weil E, Uy CC, Devinsky O, Weiner HL. Quality of life following epilepsy surgery for children with tuberous sclerosis complex. Epilepsy Behav 2011; 20:561-5. [PMID: 21288778 DOI: 10.1016/j.yebeh.2010.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 10/29/2010] [Accepted: 11/01/2010] [Indexed: 11/18/2022]
Abstract
Parents of children with tuberous sclerosis complex who underwent multistage resections for treatment of refractory seizures were offered a telephone questionnaire regarding quality of life (QOL) of child and family since surgery. Of 53 families, 39 responded. Age at epilepsy onset was birth to 3 months. Average duration of epilepsy before the first surgery was 5.1 years, and average age at surgery was 5.8. The average follow-up was 3.9. Seventy-seven percent had a >90% reduction in disabling seizures. In all outcome categories, 46-85% had at least a moderate improvement in QOL. There was a significant correlation between QOL variables and Engel outcome class. Despite the potential burden posed by the aggressive surgical approach, including multiple surgeries and long hospitalization periods, 94% of parents would choose the same course once again. We conclude that aggressive surgical treatment of tuberous sclerosis complex-related refractory seizures is associated with significant control of epilepsy as well as improved QOL for the patient and family.
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Affiliation(s)
- Jonathan Roth
- Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA.
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Gagliardi IC, Guimarães CA, Souza EA, Schmutzler KM, Guerreiro MM. Quality of life and epilepsy surgery in childhood and adolescence. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:23-6. [DOI: 10.1590/s0004-282x2011000100006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/09/2010] [Indexed: 05/26/2023]
Abstract
Epilepsy can affect the quality of life (QOL) of patients. The temporal lobe epilepsy (TLE) is often refractory to medication, which has an adverse impact on QOL. The surgery can be a form to control the seizures and to improve the QOL of the patients. OBJECTIVE: The aim of this study was to verify the QOL of children and adolescents with TLE who underwent surgery for epilepsy, comparing QOL before and after surgery and investigating which parameters showed improvement. METHOD: We used semi-structured questionnaire in the pre-and post-surgery in 13 patients. The data were analyzed using the Wilcoxon test. RESULTS: The analysis showed that there was general improvement in the QOL postoperatively. There was improvement in general health issues, adverse effects of antiepileptic drugs and the relationship with parents. CONCLUSION: When properly indicated, epilepsy surgery improves quality of life of patients with TLE.
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Dagar A, Chandra PS, Chaudhary K, Avnish C, Bal CS, Gaikwad S, Garg A, Sarkar C, Srivastava A, Padma MV, Rekha D, Gulati S, Paul V, Prasad K, Singh MB, Tripathi M. Epilepsy surgery in a pediatric population: a retrospective study of 129 children from a tertiary care hospital in a developing country along with assessment of quality of life. Pediatr Neurosurg 2011; 47:186-93. [PMID: 22213776 DOI: 10.1159/000334257] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 09/25/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the outcome of a pediatric population operated for drug-resistant epilepsy from a large tertiary care center in India. METHODS Retrospectively: quality of life (QOL); prospectively: preoperative assessment included interictal EEG, MRI (as per epilepsy protocol), video-EEG. Ictal SPECT (with subtraction) and PET were performed when required. QOL scores were assessed using the HASS or SSQ for seizure severity, Quality of Life in Childhood Epilepsy (QOLCE) for QOL, and Child Behavior Check List (CBCL) for behavior. RESULTS 142 were operated from January 2000 to June 2011 by the senior author. 118 patients with at least 1 year of follow-up were included in the study. Mean age at surgery was 9.8 ± 4.3 years. In addition, 40 patients underwent QOL assessment prospectively both before and after surgery. Mean duration of epilepsy was 5.3 ± 3.3 years. A class I outcome (Engel's) was seen in 79.5% patients, class II in 8.6%, class III in 10.7%, and class IV in 1 patient. As per surgical procedures, class I outcome in patients who underwent temporal resection, hemispherotomy and extratemporal resection was 76, 87 and 72%, respectively. QOL scores correlated with duration of seizures, epileptic encephalopathy and outcome of surgery, but not with side of surgery, age and sex. CONCLUSIONS This study, the largest reported from India, has demonstrated satisfactory results for epilepsy surgery in children.
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Affiliation(s)
- Amit Dagar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Lach LM, Elliott I, Giecko T, Olds J, Snyder T, McCleary L, Whiting S, Lowe A, Nimigon J, Smith ML. Patient-reported outcome of pediatric epilepsy surgery: social inclusion or exclusion as young adults? Epilepsia 2010; 51:2089-97. [PMID: 20477845 DOI: 10.1111/j.1528-1167.2010.02584.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to examine the social relationships and participation in educational, vocational, and community life in young adults who had undergone epilepsy surgery during childhood or adolescence. METHODS This was a retrospective, cross-sectional, case-controlled, and multisite design study. Findings were compared between young adults who had undergone epilepsy surgery and were seizure-free in the previous 12 months (n = 38), those who had undergone epilepsy surgery and were not seizure-free (n = 33), and a group of individuals with epilepsy who had not undergone surgery (n = 31). RESULTS The surgical seizure-free group had significantly better general social well-being than the other two groups. Specifically, these participants were employed for more months over the past year, were less likely to report that epilepsy had affected their employment, and were more likely to belong to at least one community organization. However, these participants were not any more likely to be involved in a relationship than those in the other two groups. In addition, there were no group differences in the reported number of friends or the frequency of visits with friends, or in what participants described as their principal activity (i.e., student, employed or unemployed). DISCUSSION There are a number of benefits to social functioning associated with having had epilepsy surgery and being seizure-free in the past year. Further research is recommended to increase our understanding of the mechanisms involved in the social and personal challenges that these individuals face.
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Affiliation(s)
- Lucyna M Lach
- School of Social Work, McGill University, Montreal, Quebec, Canada
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Mathiak KA, Łuba M, Mathiak K, Karzel K, Wolańczyk T, Szczepanik E, Ostaszewski P. Quality of life in childhood epilepsy with lateralized epileptogenic foci. BMC Neurol 2010; 10:69. [PMID: 20716372 PMCID: PMC2931463 DOI: 10.1186/1471-2377-10-69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 08/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measuring quality of life (QOL) helps to delineate mechanisms underlying the interaction of disease and psychosocial factors. In adults, epileptic foci in the left temporal lobe led to lower QOL and higher depression and anxiety as compared to the right-sided foci. No study addressed the development of QOL disturbances depending on the lateralization of epileptogenic focus. The objective of our study was to examine QOL in children with lateralized epileptiform discharges. METHODS Thirty-one parents of children with epilepsy filled the Health-Related Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). Fifteen children had foci in the left hemisphere and sixteen in the right, as verified with Electroencephalography (EEG) examinations. RESULTS We found a significant correlation between foci lateralization and reduced QOL (Spearman's rho = 0.361, p < 0.046). Children with right hemispheric foci exhibited lower overall QOL, particularly in five areas: anxiety, social-activities, stigma, general-health, and quality-of-life. CONCLUSIONS We demonstrated for the first time that in children left- and right-hemispheric foci were associated with discordant QOL scores. Unlike in adults, foci in the right hemisphere led to worse emotional and social functioning demonstrating that seizures impact the brain differentially during development.
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Affiliation(s)
- Krystyna A Mathiak
- Department of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen University, Germany
- Faculty of Psychology, University of Warsaw, Poland
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Germany
| | | | - Klaus Mathiak
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Germany
- INM-1, Forschungszentrum Jülich GmbH, Germany
| | | | - Tomasz Wolańczyk
- Department of Child Psychiatry, Medical University of Warsaw, Poland
| | - Elżbieta Szczepanik
- Clinic of Neurology of Children and Adolescents, Institute of Mother and Child, Warsaw, Poland
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