Executive dysfunction is a significant predictor of poor quality of life in children with epilepsy.
OBJECTIVE
Based on prior research indicating poor health-related quality of life (HRQOL) in children with attention-deficit/hyperactivity disorder, we investigated (1) whether executive functioning deficits were related to poor HRQOL in children with epilepsy, (2) how important these variables were in comparison to known predictors of HRQOL such as neurological factors, and (3) the extent to which clinical-level impairments in executive dysfunction predispose children to low HRQOL.


METHODS
Data included scores on the Behavior Rating Inventory of Executive Function (BRIEF) and HRQOL scales (The Impact of Childhood Illness Scale [ICI] and Hague Restrictions in Epilepsy Scale [HARCES]) for 121 children (mean age = 11.9, SD = 3.6) from a tertiary center serving children with severe epilepsy.


RESULTS
Correlations between the BRIEF and ICI total and subscore domains (child, parent, family, and treatment) were generally significant and moderate (e.g., r > or = 0.30, p < or = 0.001). BRIEF Global Executive Composite, number of antiepileptic drugs (AEDs), number of prior AEDs, and adaptive level all emerged as significant and unique predictors of HRQOL (R(2)= 0.36, adj. R(2)= 0.33, p < 0.0001). A clinically elevated BRIEF was associated with a twofold risk of low HRQOL (odds ratio = 2.21, p = 0.03).


CONCLUSIONS
Executive dysfunction appears to exert a broad adverse influence on HRQOL in children with epilepsy, with clinical-level impairments in executive dysfunction contributing to a twofold increase in the likelihood of poor HRQOL. The constellation of executive dysfunction, low adaptive level, high medication load, and a history of several failed AEDs are risk factors for poor HRQOL in children with epilepsy.
Sherman
Elisabeth M S
EM
Alberta Children's Hospital, Calgary, Alberta, Canada. elisabeth.sherman@calgaryhealthregion.ca
Slick
Daniel J
DJ
Eyrl
Kim L
KL
D000367:Age Factors; D000927:Anticonvulsants / Q000627:therapeutic use; D001927:Brain Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D005625:Frontal Lobe / Q000503:physiopathology*; D006304:Health Status; D006801:Humans; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D016017:Odds Ratio; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011594:Psychometrics; D011788:Quality of Life; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012917:Social Adjustment
D000927:Anticonvulsants