Quality of Life of Children With Benign Rolandic Epilepsy

doi:10.1016/j.pediatrneurol.2006.03.012

Pediatric Neurology

Volume 35, Issue 4, October 2006, Pages 240-245

https://doi.org/10.1016/j.pediatrneurol.2006.03.012 Get rights and content

The first objective of this study was to determine the quality of life of children with benign rolandic epilepsy. Secondly, this investigation aimed to predict the influence of cognition on quality of life, controlling for the emotional impact of the epilepsy on the parent. Initial recruitment was through the major electroencephalography laboratories of metropolitan Sydney. The syndrome was defined using the International League Against Epilepsy classification. Patients underwent a comprehensive cognitive assessment, and parents completed the Child Health Questionnaire, Child Behavior Checklist, and Quality of Life in Childhood Epilepsy Questionnaire. Parental emotional impact was assessed using a subscale from the Child Health Questionnaire. The cohort included 30 patients (22 males, 8 females), mean age 9.67 years. There was a higher incidence of competence problems compared with normative data. The average psychosocial score was significantly lower than normative data. Controlling for parental emotional impact, general intellectual ability predicted quality of life in the areas of self-esteem and language. Clinical variables had minimal impact and were not included in the regression models. Parental emotional impact, however, was a major independent predictor of quality of life. Quality of life may be compromised in children with benign rolandic epilepsy and is related to cognitive variables and emotional impact of the epilepsy on the parent.

Introduction

Epilepsy may compromise the ability of the child and family to function effectively [1], [2]. Quality of life is an important outcome measure used to assess the impact of epilepsy upon life function. It is increasingly recognized as a critical component in the evaluation and treatment of epilepsy [2], [3], [4], [5], [6], [7]. In benign rolandic epilepsy the prognosis for seizure outcome is excellent [8]. Because of the benign nature of the epilepsy, it is generally presumed that quality of life is not significantly affected. As such, there is a paucity of research in this area. Previously our group assessed quality of life in a small sample of children with benign rolandic epilepsy and found a higher incidence of competence problems relating to reduced participation in social activities, friendships, home responsibilities, and academic difficulties (12 of 21 children), compared with normative data [7]. Problem behaviors, pertaining to mental health and externalizing behaviors such as delinquency, were not found to be elevated [7]. In contrast, Weglage et al. [9], using only the problem behavior scale of the Child Behavior Checklist, found that children with benign rolandic epilepsy experienced significantly more behavioral problems, on average, compared with a matched control group.

In the current study, the first aim was to further investigate the quality of life of a cohort of children with benign rolandic epilepsy, using the Child Health Questionnaire [10] and the Child Behavior Checklist [11]. These two generic instruments have been used in previous research to assess quality of life in childhood epilepsy [6], [7], [12]. Patients were recruited from multiple electroencephalography laboratories, and the International League Against Epilepsy Classification [13] was utilized, together with strict inclusion and exclusion criteria, to ensure the sample was representative of the typical syndrome and not biased by tertiary referral.

The second aim of the study was to determine the factors that impact on quality of life using an epilepsy-specific quality of life measure. The study utilized the Quality of Life in Childhood Epilepsy Questionnaire, developed and validated by our unit for research into childhood epilepsy [12]. The Questionnaire has demonstrated sensitivity to clinical variables, including seizure frequency and medication [12], and intellectual disability [6]. As children with benign rolandic epilepsy may experience neuropsychological and language difficulties [9], [14], [15], [16], [17], [18], [19], we hypothesized that cognition also impacts on quality of life in this syndrome.

While there is some agreement between parent-rated instruments and child self-report [20], the former has been criticized as constituting proxy measures not adequately reflecting the child’s perception [21]. Research has indicated that parental anxiety is an important predictor of reduced quality of life in children with epilepsy [22]. Therefore it is possible that the discrepancy mentioned above is partially explained by parental anxiety. As the Quality of Life in Childhood Epilepsy Questionnaire is a parent-rated instrument, we controlled for the degree of worry or concern a parent experiences regarding the child’s physical/mental health and behavior using the Parental Emotional Impact scale from the Child Health Questionnaire. Also investigated was the influence of relevant clinical variables on quality of life.

Section snippets

Recruitment

The recruitment for a larger study investigating electroencephalographic features in 60 children with benign rolandic epilepsy was previously described [17], [23]. The neurophysiologic reports of all children with centrotemporal discharges aged 3-15 years were selected from six electroencephalography laboratories between June 2000 and November 2003. One author (A.Be.) reviewed the electroencephalograms of those children whose reports recorded centrotemporal discharges to determine if the

Patient Demography

Thirty patients (22 males and 8 females) with a mean age of 9.67 years (range 7-12 years) participated in the study. The mean age of epilepsy onset was 7 years (range 3-11 years). At the time of assessment the median duration of epilepsy was 1 year and 9 months (range 5 months to 5 years 9 months). Fifteen children experienced seizures in the prior 6 months and on the Child Seizure Profile were described as: very mild (3), mild (5), moderate (4), and severe (3). Nineteen children were on

Discussion

The first aim of the study was to further investigate the quality of life of children with benign rolandic epilepsy. There is a paucity of scientific data addressing this issue [7], [9]. The present study demonstrated that some children with benign rolandic epilepsy have difficulties as assessed by the generic life function questionnaires, the Child Behavior Checklist, and Child Health Questionnaire.

In the domain of competence, as measured by the Child Behavior Checklist, six children (21%)

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The effect of executive function on health related quality of life in children with self-limited epilepsy with centrotemporal spikes
2024, Epilepsy and Behavior
The current study aims to investigate the effect of Executive Functions (EFs) on Health Related Quality of Life (HRQoL) in a cohort of children with self-limited epilepsy with centrotemporal spikes (SeLECTS) and to identify possible factors that impact HRQoL specifically related to epilepsy-related variables and EFs skills.
The Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) and The Behavior Rating Inventory of Executive Function (BRIEF-2 and BRIEF-P) were completed by the parents of 129 patients with SeLECTS. Demographic variables and epilepsy-related variables were collected.
Our sample performed in the average range across all the subscales and summary scores of the PedsQL and performed in the normal range of the BRIEF questionnaire. We observed that a lower functioning in EFs was associated with lower overall HRQoL scores. We explored the relationship between epilepsy characteristics and scores on the PedsQL. We found that the use of antiseizure medications (ASMs), longer duration of the treatment, and a higher seizure frequency were associated with a lower HRQoL. Moreover, we observed that executive dysfunction was a significant predictor of reduced HRQoL.
Our results suggest the importance of the identification of patients with SeLECTS with a high level of risk for a poor HRQoL. We may now add executive dysfunction to the list of known risk factors for poor HRQoL in children with SeLECTS, along with such factors as seizure frequency, recent seizures, use of ASMs and longer duration of therapy. The early identification of children with SeLECTS at risk of a poor HRQoL could allow the activation of adequate interventions.
The contribution of sleep and co-occurring neurodevelopmental conditions to quality of life in children with epilepsy
2023, Epilepsy Research
Health-related quality of life (HRQOL) in children with epilepsy (CWE) is multifactorial and can be affected not only by epilepsy-specific variables but also co-occurring conditions such as sleep disturbances, autism, and attention deficit hyperactivity disorder (ADHD). While highly prevalent in CWE, these conditions are underdiagnosed despite having a significant impact on HRQOL. Sleep problems have a complex relationship with epilepsy and neurodevelopmental characteristics. However, little is known about how these issues interact and contribute to HRQOL.
The current study aims to explore the relationship between sleep and neurodevelopmental characteristics on HRQOL in CWE.
36 CWE aged 4–16 years old were recruited from two hospitals and asked to wear an actiwatch for a period of 14 days and caregivers completed a series of questionnaires assessing co-occurrences and epilepsy-specific variables.
A high proportion of CWE (78.13%) presented significant sleep problems. Informant-reported sleep problems were significantly predictive of HRQOL above seizure severity and the number of antiseizure medications. Interestingly, informant-reported sleep problems were no longer significantly predictive of HRQOL when neurodevelopmental characteristics were considered, indicating a possible mediating effect. Similarly, actigraphy-defined sleep (variability in sleep onset latency) displayed a similar effect but only for ADHD characteristics, whereas autistic characteristics and variability in sleep onset latency continued to exert an individual effect on HRQOL.
These data from our study shed light on the complicated relationship between sleep, neurodevelopmental characteristics and epilepsy. Findings suggest that the impact of sleep on HRQOL in CWE is possibly mediated by neurodevelopmental characteristics. Furthermore, the impact this triangular relationship exerts on HRQOL is dependent on the type of tool used to measure sleep. These findings highlight the importance of a multidisciplinary approach to epilepsy management.
Clinical application of the PedsQL Epilepsy Module (PedsQL-EM) in an ambulatory pediatric epilepsy setting
2020, Epilepsy and Behavior
Children with epilepsy report lower health-related quality of life (QOL) compared with healthy children and those with other chronic disorders. This study piloted the recently published Pediatric Quality of Life Inventory (PedsQL) Epilepsy Module (PedsQL-EM) in an ambulatory setting and studied epilepsy-related factors contributing to QOL in children with epilepsy.
Children with epilepsy aged 8–18 years who were ambulant and verbal were recruited from pediatric neurology clinics. Children and their caregivers completed age-appropriate versions of the PedsQL-EM (8–12 or 13–18 years) in the clinic waiting area. Treating neurologists completed medical questionnaires about their patients' epilepsy.
We collected 151 parent-report and 127 self-report PedsQL-EMs. Administration time was 5–10 min with some children receiving assistance from the researcher. Mean age of children was 12.9+/-3.0, with 77 females (51%). Parents reported lower mean QOL scores across all subdomains compared with their children. Parents reported significantly lower QOL for children with earlier age at epilepsy onset, longer epilepsy duration, presence of seizures during the last month, more severe epilepsy, increased number of antiepileptic drugs (AEDs), and cognitive comorbidity. The same factors impacted on child self-reporting, but with more variability across subdomains.
The PedsQL-EM is an epilepsy-specific measure of QOL that is quick and easy to administer and is sensitive to the clinical factors reported to impact on QOL in pediatric epilepsy.
Effects of adjunctive eslicarbazepine acetate on neurocognitive functioning in children with refractory focal-onset seizures
2018, Epilepsy and Behavior
This was a phase-II, randomized, double-blind (DB), placebo-controlled study aimed to evaluate neurocognitive effects of eslicarbazepine acetate (ESL) as adjunctive therapy in pediatric patients with refractory focal-onset seizures (FOS).
Children (6–16 years old) with FOS were randomized (2:1) to ESL or placebo. Treatment started at 10 mg/kg/day, was up-titrated up to 30 mg/kg/day (target dose), and maintained for 8 weeks, followed by one-year open-label follow-up. The primary endpoint was change from baseline to the end of maintenance period in the composite Power of Attention assessed with the Cognitive Drug Research (CDR) system. Behavioral and emotional functioning and quality of life (QOL), secondary endpoints, were assessed with Child Health Questionnaire-Parent Form 50 (CHQ-PF50), Child Behavior Checklist (CBCL), and Raven's Standard Progressive Matrices (SPM). Efficacy was evaluated through changes in standardized seizure frequency (SF), responder rate, and proportion of seizure-free patients. Safety was evaluated by the incidence of treatment-emergent adverse events (TEAEs).
One hundred and twenty-three patients were randomized. A noninferiority analysis failed to reject the null hypothesis that the change from baseline in the Power of Attention score in the ESL group was at least 121 ms inferior to the placebo group for all age groups. The CDR scores showed no differences between placebo and ESL in Power of Attention (1868.0 vs 1759.5), Continuity of Attention (1.136 vs − 1.786), Quality of Working Memory (− 0.023 vs − 0.024), and Speed of Memory (− 263.4 vs − 249.6). Nonsignificant differences between placebo and ESL were seen for CHQ-PF50, CBCL scores, and Raven's SPM. Episodic Memory Index showed significant negative effect on ESL. Efficacy results favored the ESL group (SF least square [LS] means 1.98 vs 4.29). The TEAEs had a similar incidence between treatment groups (41.0% vs 47.5%).
Overall ESL did not produce statistically significant effects on neurocognitive and behavioral functioning in patients with epilepsy aged 6 to 16 years. Additionally, ESL was effective in reducing seizure frequency and was well-tolerated.
Idiopathic focal epilepsies
2013, Handbook of Clinical Neurology
Citation Excerpt :
We have reviewed a large list of transient neuropsychological impairments seen in children with atypical features of BCECTS (Fejerman, 2009). It is interesting to note that in a study investigating the influence of cognition on the quality of life of 30 children with BCECTS, parental emotional impact was considered the major independent predictor of quality of life (Connolly et al., 2006). On the other hand, even when children with BCECTS show some learning difficulties, the intellectual abilities or behavior disorders did not differ from the healthy children, and a vast majority of the patients are able to attend normal schools.
In this chapter we include a series of epilepsies with onset in pediatric age characterized by focal seizures, idiopathic etiology, normal psychomotor development, and a benign course related to the spontaneous remission of seizures without sequelae. These entities are age-dependent and seizures tend to disappear spontaneously. For these reasons often the drug treatment is not necessary. On the basis of genetic assessment idiopathic focal epilepsies can be divided into two groups: nonautosomal dominant and autosomal dominant.
In the group of nonautosomal entities we include benign epilepsy with centro-temporal spikes, Panayiotopoulos syndrome, idiopathic childhood occipital epilepsy described by Gastaut, and benign idiopathic midline spikes epilepsy. Seizures are rare, sometimes prolonged, as autonomic status in Panayiotopoulos syndrome. A common feature is the presence of peculiar EEG interictal paroxysmal abnormalities.
In the group with an autosomal dominant mode of inheritance we include benign familial infantile seizures and benign familial neonatal–infantile seizures. These entities are characterized by partial seizures in cluster, self-limited in a brief period during the first months of life. There are no typical interictal EEG abnormalities. In some families a mutation in SCN2A, the gene coding for the 2α subunit of the voltage-gated sodium channel, has been described.
Benign rolandic epileptiform discharges are associated with mood and behavior problems
2011, Epilepsy and Behavior
Children with benign rolandic epilepsy (BRE) experience elevated rates of cognitive, behavioral, and affective problems. Frequent epileptiform spike discharges may impair behavioral functioning. To elucidate this relationship, we evaluated associations between the EEG spike frequency index (SI) and parental ratings of psychosocial adjustment and executive functioning in school-aged children with EEGs typical of BRE. Twenty-one children (6–12 years) participated. Parents completed validated questionnaires at a median of 5 months (range: 1–8) after a routine outpatient EEG. The EEG SI was calculated for wakefulness and sleep. The strength of association between the SI and behavioral variables was evaluated by simple and multivariate correlation. Higher awake and sleep SIs were associated with more symptoms of depression (P < 0.001), aggression and conduct problems (P < 0.01). Higher sleep SI was associated with executive dysfunction and anxiety (P < 0.05). Symptoms of hyperactivity and inattention had no correlation. Increased epileptiform activity in children with BRE may predict higher rates of mood and behavioral problems.

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Original articleQuality of Life of Children With Benign Rolandic Epilepsy

Introduction

Section snippets

Recruitment

Patient Demography

Discussion

The psychosocial burden of epilepsy

Epilepsia

Behavioral issues in pediatric epilepsy

Neurology

Assessment of quality of life in people with epilepsy: Some practical implications

Epilepsia

The impact of epilepsy on quality of life: A qualitative analysis

Epilepsy Behav

The meaning of quality of life to patients with epilepsy

Epilepsy Behav

The health-related quality of life of children with refractory epilepsy: A comparison of those with and without intellectual disability

Epilepsia

The health-related quality of life of childhood epilepsy syndromes

J Paediatr Child Health

The course of benign partial epilepsy of childhood with centrotemporal spikes

Neurology

Neuropsychological, intellectual, and behavioral findings in patients with centrotemporal spikes with and without seizures

Dev Med Child Neurol

Manual for the Child Behavior Checklist/4-18 and 1991 Profile

Validation of a new quality of life measure for children with epilepsy

Epilepsia

Proposal for revised classification of epilepsies and epileptic syndromes

Epilepsia

Neuropsychological disorders related to interictal epileptic discharges during sleep in benign epilepsy of childhood with centrotemporal or rolandic spikes

Dev Med Child Neurol

Neuropsychological findings in children with benign childhood epilepsy with centrotemporal spikes

Dev Med Child Neurol

Neuropsychological features of benign partial epilepsy in children

Ital J Neurol Sci

Original article
Quality of Life of Children With Benign Rolandic Epilepsy