title: Risk factors for health-related quality of life in children with epilepsy: a meta-analysis.
abstract: OBJECTIVE
  The aims of this study were to conduct a meta-analysis of risk factors for health-related quality of life (HRQL) in children with epilepsy; interpret the results in terms of study quality; and, assess the nature and source of heterogeneity of estimates.
  
  
  METHODS
  Databases were searched for studies that examined HRQL in pediatric epilepsy. The inclusion criteria were original studies published in English from 1994 through to the end of January 2014; children ≤18 years of age with epilepsy; included a parent- or self-reported measure of HRQL; and, data were presented such that the calculation of a correlation coefficient was possible. Study quality was measured using a modified Quality Index.
  
  
  RESULTS
  A total of 12 risk factors from 21 studies were analyzed. The mean Quality Index score was 10.4 (standard deviation [SD] 1.9). Correlations between risk factors and HRQL had a minimum of r = -0.03 and a maximum of r = -0.44. Child sex, age, and age at onset were not significantly associated with HRQL. Duration of epilepsy, seizure type, frequency, and severity, number of antiepileptic drugs, side effects of antiepileptic drugs, presence of a comorbidity, parental anxiety, and family socioeconomic status were significantly associated with HRQL. Informant (child vs. parent), year of publication, and study quality were found to be sources of heterogeneity for certain risk factors.
  
  
  CONCLUSIONS
  Results demonstrated that a variety of clinical and family factors are associated with HRQL in children with epilepsy and have implications for research and practice. Future research should focus on longitudinal studies to identify predictors of HRQL that are amenable to intervention and should evaluate whether changes in these predictors result in more favorable HRQL in children with epilepsy.
authors.affiliation: Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Pediatrics, McMaster University, Hamilton, Ontario, Canada; Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ferro
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D011788:Quality of Life; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires
keywords: Child; Epilepsy; Meta-analysis; Quality of life; Risk factors; Statistical models; Study quality