Psychiatric and neurodevelopmental comorbidities, more than seizure history or antiepileptic drug use, determine poorer long-term quality-of-life outcomes in children with epilepsy in remission.
SAN DIEGO—Among adolescents with childhood-onset epilepsy, psychiatric and neurodevelopmental comorbidities negatively affect quality of life, even after seizures remit, according to research presented at the 136th Annual Meeting of the American Neurological Association.
Researchers from the Department of Neurology at the University of California in Los Angeles and the Children’s Memorial Hospital of Chicago assessed patient- and parent-proxy reported quality of life in a sample of children with epilepsy. They found that the presence of neurodevelopmental spectrum or psychiatric disorders contributed to a lower health-related quality of life, compared with children with epilepsy who did not have these comorbidities, as well as healthy siblings.
Measuring the Impact of Epilepsy After Seizure Remission
In their prospective, community-based study, lead author Christine Baca, MD, and colleagues included a total of 277 children with epilepsy, 177 of whom were seizure-free for five or more years at nine-year follow-up. The investigators also identified 92 case-control matched pairs (consisting of a seizure-free patient and a control sibling) for the 177 children. Quality of life was assessed with the Child Health Questionnaire (CHQ), a self-administered generic measure with child and parent-proxy versions, which was completed by children with epilepsy and by parents of patients and sibling controls.
“Mean health-related quality of life was significantly higher (better) for sibling controls compared to children with epilepsy who were seizure-free for five years or more on one-half of the parent-proxy–reported CHQ scales,” the investigators reported. “There were no differences between child self-reported cases and controls in health-related quality of life, although there was a trend for higher health-related quality of life among controls.”
When the researchers examined seizure history among the 177 children with epilepsy who were seizure-free for more than five years at follow-up, they found that 81 (45.8%) had one to 10 seizure days in the first four years after diagnosis, 52 (29.4%) had 11 or more seizure days, and 44 (25.6%) were seizure-free. Parent-proxy reported quality of life was worse for patients with more than 11 seizure days compared with the other patient groups, but no association was found between child-reported quality of life and remote seizure history.
Epilepsy and Comorbidities
“Children with epilepsy with a higher remote seizure day history were significantly more likely to have psychiatric or neurodevelopmental spectrum disorder comorbidity, be on AEDs, or have an IQ 80 or lower,” Dr. Baca and colleagues reported.
At nine-year follow-up, 59 (21.3%) of the 277 children with epilepsy had a neurodevelopmental spectrum disorder (including developmental delay, language delay, language problem, dyslexia, and autism), and 22 (7.9%) had a psychiatric disorder (including depression, anxiety disorder, bipolar disorder, obsessive-compulsive disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, and conduct disorder). Forty-nine children (17.7%) had both types of comorbidity, and 147 (53.1) had neither.
“Having a psychiatric disorder was significantly associated with lower health-related quality of life across the majority of child and parent-proxy–reported CHQ scales, although early seizure history and current AED use were not,” the researchers stated.
“Among children with epilepsy in remission, psychiatric comorbidities are important determinants of poor long-term quality-of-life outcomes, above and beyond the impact of seizures and AEDs,” the researchers concluded. “High-quality comprehensive epilepsy care needs to include the management of chronic psychiatric comorbidities, given their potential association with poor long-term psychosocial outcomes, even when seizures remit.”