Puka Klajdi, Smith Mary Lou
Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada.
Epilepsia. 2015 Jun;56(6):873-81. doi: 10.1111/epi.13004. Epub 2015 May 4.
This study examined the influence of seizures, antiepileptic drugs (AEDs), intelligence quotient (IQ), and symptoms of depression and anxiety on health-related quality of life (HRQOL) 4-11 years after pediatric epilepsy surgery.
Participants were 109 patients with childhood-onset intractable epilepsy; 71 had undergone surgery on average 6.9 years before this study. Patients and their parents completed questionnaires assessing HRQOL and internalizing behavior, a measure of depression and anxiety symptoms.
Similar rates of recent seizure freedom were found for surgical and nonsurgical patients, although surgical patients had achieved seizure freedom sooner and with fewer AEDs. Few differences were found between surgical and nonsurgical patients. Differences emerged when comparing patients with continued seizures and those who had been seizure-free in the 12 months preceding the study. Almost all HRQOL ratings were enhanced in seizure-free patients. Internalizing behavior (anxiety/depression) mediated the relationship between seizure freedom and better HRQOL, where seizure freedom led to better ratings of anxiety/depression, which in turn led to better ratings of HRQOL. AED use was found to be associated with social functioning, medication effects, and seizure worry. IQ and duration of follow-up were not found to independently influence HRQOL.
The findings highlight the integral role of depression and anxiety symptoms in determining HRQOL; seizure control seems to play a secondary role. This study expands this relationship to individuals who have a history of intractable childhood epilepsy. The findings highlight the importance of managing depression and anxiety in improving the HRQOL and reducing seizure burden on patients.
本研究探讨了癫痫发作、抗癫痫药物（AEDs）、智商（IQ）以及抑郁和焦虑症状对小儿癫痫手术后4至11年健康相关生活质量（HRQOL）的影响。
研究对象为109例儿童期起病的难治性癫痫患者；其中71例平均在本研究前6.9年接受了手术。患者及其父母完成了评估HRQOL和内化行为的问卷，内化行为是抑郁和焦虑症状的一种测量指标。
手术患者和非手术患者近期无癫痫发作的比例相似，尽管手术患者实现无癫痫发作的时间更早且使用的AEDs更少。手术患者和非手术患者之间几乎没有差异。在比较研究前12个月内仍有癫痫发作的患者和无癫痫发作的患者时出现了差异。几乎所有HRQOL评分在无癫痫发作的患者中都有所提高。内化行为（焦虑/抑郁）介导了无癫痫发作与更好的HRQOL之间的关系，即无癫痫发作导致焦虑/抑郁评分更好，进而导致HRQOL评分更好。发现AEDs的使用与社会功能、药物作用和癫痫担忧有关。未发现IQ和随访时间独立影响HRQOL。
研究结果突出了抑郁和焦虑症状在决定HRQOL中的重要作用；癫痫控制似乎起次要作用。本研究将这种关系扩展到有儿童难治性癫痫病史的个体。研究结果强调了管理抑郁和焦虑对改善HRQOL以及减轻患者癫痫负担的重要性。
