Mitchell W G, Scheier L M, Baker S A
Department of Neurology, University of Southern California School of Medicine, Childrens Hospital, Los Angeles 90027.
Pediatrics. 1994 Oct;94(4 Pt 1):471-7.
We studied factors predicting the risk of adverse long-term psychosocial, behavioral, and medical outcomes in children with epilepsy.
Children (N = 157, 4.5 to 13 years) were enrolled in a prospective longitudinal study when first seen. Potential subjects were excluded if they were moderately or severely mentally retarded, had motor or sensory handicaps interfering with testing, or did not speak either English or Spanish.
To develop risk predictors, we collected information regarding the child's medical and seizure history, cognitive functioning, and behavior problems, and family functioning. Children and their families were followed for a minimum of 18 months, then underwent reassessment of medical status, parent's attitudes toward epilepsy, and the child's behavioral and cognitive functioning. Data were analyzed by confirmatory factor analysis to develop baseline factors (Sociocultural Risk, Seizure Risk, and Behavior Problems) and outcome factors (Medical/Seizure Problems, Parent's Negative Attitudes Toward Epilepsy, and Behavior Problems), followed by structural equation modeling to determine across-time causal effects. Eighty-eight subjects completed all baseline and outcome measures.
Among significant across-time effects, Medical Outcome was predicted by Seizure Risk. An increased number of stressful life events predicted better Medical Outcome. Low acculturation increased Parent's Negative Attitudes and was associated with increased Behavior Problems at baseline. Behavior Problems were stable across time. It is interesting that IQ did not affect any of the outcomes, although its effect may have been mediated through other baseline measures.
Seizure history was the best predictor of ongoing medical difficulties, whereas the most important causes of ongoing parental anxiety and negative attitudes toward epilepsy were sociocultural. Variation in medical or attitudinal outcomes was not influenced by either the child's IQ or reported behavioral problems. These findings suggest that to alter attitudes toward epilepsy, programs should be tailored to the sociocultural background of the family. Studies of quality of life of children with epilepsy should include appropriate sociocultural measures.
我们研究了预测癫痫患儿长期不良心理社会、行为和医学结局风险的因素。
儿童（N = 157，4.5至13岁）首次就诊时纳入一项前瞻性纵向研究。如果潜在受试者为中度或重度智力障碍、存在干扰测试的运动或感觉障碍，或者既不会说英语也不会说西班牙语，则将其排除。
为了开发风险预测指标，我们收集了有关儿童的医学和癫痫发作史、认知功能、行为问题以及家庭功能的信息。对儿童及其家庭进行至少18个月的随访，然后重新评估医学状况、父母对癫痫的态度以及儿童的行为和认知功能。通过验证性因素分析对数据进行分析，以确定基线因素（社会文化风险、癫痫发作风险和行为问题）和结局因素（医学/癫痫发作问题、父母对癫痫的消极态度和行为问题），随后进行结构方程建模以确定跨时间的因果效应。88名受试者完成了所有基线和结局测量。
在显著的跨时间效应中，癫痫发作风险可预测医学结局。压力性生活事件数量增加可预测更好的医学结局。文化适应程度低会增加父母的消极态度，并与基线时行为问题增加相关。行为问题随时间保持稳定。有趣的是，智商并未影响任何结局，尽管其影响可能通过其他基线测量指标介导。
癫痫发作史是持续存在医学困难的最佳预测指标，而父母持续焦虑和对癫痫持消极态度的最重要原因是社会文化因素。医学或态度结局的差异不受儿童智商或报告的行为问题影响。这些发现表明，为了改变对癫痫的态度，项目应根据家庭的社会文化背景进行调整。癫痫患儿生活质量研究应包括适当的社会文化测量指标。
