Modi Avani C, Gutierrez-Colina Ana M, Wagner Janelle L, Smith Gigi, Junger Katherine, Huszti Heather, Mara Constance A
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America.
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America.
Epilepsy Behav. 2019 Jan;90:112-118. doi: 10.1016/j.yebeh.2018.11.026. Epub 2018 Dec 7.
The objectives of this study were to identify executive functioning (EF) phenotypes in youth with epilepsy and to examine whether phenotypes differ on psychosocial and medical outcomes (i.e., absence/presence of seizures in the past three months), health-related quality of life (HRQOL), and emotional and behavioral functioning.
Youth 5-18 years with diagnosed epilepsy and caregivers completed a battery of questionnaires as part of a larger national validation of the Pediatric Quality of Life (PedsQL) Epilepsy Module. The primary measure of interest was the Behavior Rating Inventory of Executive Function-Parent Form. Medical chart reviews and demographic data were also collected. Latent class analysis was used to identify EF phenotypes. Chi-square and analyses of covariance (ANCOVA) were conducted to examine EF phenotype group differences on seizure outcomes, HRQOL, and behavioral and emotional functioning.
Two-hundred and thirty-seven children with epilepsy (M = 11.2 years; 56% female; 60% White: Non-Hispanic; 55% experienced seizures in the past three months) and their caregivers participated. Four EF phenotypes were identified: Group 1 - No EF deficits (45% of sample), Group 2 - Global EF deficits (29% of sample), Group 3 - Behavioral Regulation + Working Memory deficits (8% of sample), and Group 4 - Metacognitive deficits (17% of sample). No significant EF phenotype group differences were found for seizure characteristics. The ANCOVAs indicated significant EF phenotype group differences on HRQOL (parent-reported Impact, Cognitive, Sleep, EF, and Mood/Behavior and child-reported Cognitive, Sleep, EF, and Mood/Behavior subscales; ps < .001) and emotional and behavioral functioning (Externalizing, Internalizing, and Behavioral Symptom Index; ps < .001), with the Global EF deficits (Group 2) and Behavioral Regulation + Working Memory deficits groups (Group 3) demonstrating the greatest level of impairment.
Phenotypic variability in EF is significantly related to patient-reported outcomes. Interventions addressing EF deficits need to be individualized to a child's particular EF phenotype to achieve optimal outcomes.
本研究的目的是确定癫痫青少年的执行功能（EF）表型，并检查这些表型在心理社会和医学结果（即过去三个月内有无癫痫发作）、健康相关生活质量（HRQOL）以及情绪和行为功能方面是否存在差异。
5至18岁被诊断患有癫痫的青少年及其照顾者完成了一系列问卷调查，作为对儿童生活质量（PedsQL）癫痫模块进行的一项更大规模全国性验证的一部分。主要关注的测量指标是执行功能行为评定量表家长版。还收集了病历审查和人口统计学数据。采用潜在类别分析来确定EF表型。进行卡方检验和协方差分析（ANCOVA），以检查EF表型组在癫痫发作结果、HRQOL以及行为和情绪功能方面的差异。
237名癫痫儿童（平均年龄M = 11.2岁；56%为女性；60%为白人：非西班牙裔；55%在过去三个月内有癫痫发作）及其照顾者参与了研究。确定了四种EF表型：第1组 - 无EF缺陷（占样本的45%），第2组 - 整体EF缺陷（占样本的29%），第3组 - 行为调节 + 工作记忆缺陷（占样本的8%），第4组 - 元认知缺陷（占样本的17%）。在癫痫发作特征方面，未发现EF表型组之间存在显著差异。ANCOVA表明，在HRQOL（家长报告的影响、认知、睡眠、EF以及情绪/行为和儿童报告的认知、睡眠、EF以及情绪/行为子量表；p值均 <.001）和情绪及行为功能（外化、内化和行为症状指数；p值均 <.001）方面，EF表型组之间存在显著差异，其中整体EF缺陷组（第2组）和行为调节 + 工作记忆缺陷组（第3组）的损害程度最大。
EF的表型变异性与患者报告的结果显著相关。针对EF缺陷的干预措施需要根据儿童特定的EF表型进行个体化，以实现最佳效果。
