Mental and Behavioral Health Symptoms Among Key Predictors of Epilepsy-Specific Health-Related Quality of Life

In a newly published questionnaire study in Epilepsy & Behavior, both patients and caregiver informants reported that mental and behavioral health symptoms as the strongest key shared predictors of health-related quality of life (HRQOL) in pediatric patients with epilepsy.¹ These findings suggest the importance of addressing these types of symptoms to provide pediatric patients who have epilepsy with quality care, including seizure management, minimal anti-seizure meditation adverse effects, and the best possible HRQOL.

Among 281 youths who completed the questionnaire, caregiver-proxy report of pediatric patients with epilepsy HRQOL indicated that Behavioral Assessment Scale for Children (BASC)-2 Externalizing (P <.05), Behavioral Symptoms (P <.01), and Adaptive Skills (P <.001) explained 58% of the variance in youth Cognitive Functioning HRQOL. At the same time, patient self-report of HRQOL showed that BASC-2 Externalizing (P <.01), Behavioral Symptoms (P <.05), and Adaptive Skills (P <.001) had only 36% of the variance in Cognitive Functioning HRQOL above and beyond the variance as shown by sociodemographic and epilepsy-specific characteristics.

“Improving HRQOL for pediatric patients managing epilepsy is a critical component of treatment success. Identification of factors impacting epilepsy-specific HRQOL allows caregivers and providers to better understand and more closely monitor mental and behavioral health symptoms so that concerns can be addressed early in clinical care, “lead author Shannon L. Brothers, PhD, assistant professor of pediatrics and clinical psychologist for the division of neurology in the Comprehensive Epilepsy Center at Cincinnati Children’s, and colleagues wrote.¹ “Current findings also provide information about potential subgroups of pediatric patients with epilepsy who may be at higher risk for impairments in specific HRQOL domains,”

The questionnaire was administered to pediatric patients with epilepsy and their caregivers which centered on sociodemographic factors, mood/anxiety and behavior symptoms, epilepsy characteristics, anti-seizure medication adverse events, and years since diagnosis, and the PedsQL Epilepsy module. The module subscales included Impact, Cognitive Functioning, Executive Functioning, Sleep, and Mood/Behavior. Investigators used hierarchical linear regressions to assess caregiver-proxy and patient self-reported factors that affect epilepsy-specific HRQOL.

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Additional results from the questionnaire were also noted for the Executive Functioning HRQOL domain, where caregiver-proxy report of pediatric patients with epilepsy HRQOL showed that BASC-2 Internalizing (P <.01), Behavioral Symptoms (P <.001) and Adaptive Skills (P <.001) had a 65% of variance in Executive Functioning. At the same time, youth self-report of Executive Functioning HRQOL revealed that caregiver-proxy BASC-2 Internalizing (P <.001) and Behavioral Symptoms (P <.01) explained 34% of the variance in Executive Functioning HRQOL, above and beyond the variance as shown by sociodemographic and epilepsy-specific characteristics. Investigators also noted that unique mental and behavioral health predictors of pediatric patients HRQOL were also observed for both caregiver-proxy and patient self-report.

“Compared to youth self-report of HRQOL, caregiver-reported models of youth HRQOL accounted for twice as much variance, showing a greater number of total and unique predictors. Across domains of caregiver-reported HRQOL, mental and behavioral health variables accounted for a significant amount of variance and were the strongest predictors of most domains,” Brothers et al noted.¹ “The most common mental and behavioral health predictors of lower HRQOL domains were more internalizing symptoms (Impact, Sleep, Mood/Behavior) and lower adaptive functioning (Impact, Executive Functioning, Sleep), while greater overall levels of behavioral problems predicted lower HRQOL Mood/Behavior.”

Investigators noted that unique epilepsy-specific predictors were also observed from the responses gathered. As an example, anti-seizure medication adverse events were noted as the most common epilepsy-specific predictor of lower HRQOL (Impact, Cognitive, Executive Functioning), with longer duration of epilepsy and suboptimal seizure control that predicted more negative HRQOL Impact while polytherapy predicted worse HRQOL Executive Functioning.

A primary limitation of the study was the dependence on self-reported questionnaires and the cross-sectional study design, as it did not allow for the longitudinal assessment of trends and potential changes in key factors that affect HRQOL. Another limitation noted was that mental and behavioral health symptoms assessed were conducted only by the caregiver report via the BASC-2. The authors suggested this is likely because of the lack of patient self-reported findings between PedsQL Epilepsy Module and BASC-2 mental and behavioral health concerns.

REFERENCES
1. Brothers SL, Clifford LM, Guilfoyle SM, et al. Key predictors of epilepsy-specific health-related quality of life (HRQOL) in youth with epilepsy. Epilepsy Behav. 2023;149:109508. doi:10.1016/j.yebeh.2023.109508