Influência do controle de crises no desenvolvimento de crianças com epilepsia : inteligência, comportamento, qualidade de vida e sono

Abstract

Introduction: The cognitive and behavioral impact of epilepsies affecting children and adolescents has a strong clinical relevance and is influenced by a number of factors, such as age of onset, underlying etiology, location of epileptogenic focus and effects of antiepileptic drugs on monotherapy or polytherapy. The aim of this study was to evaluate the impact of uncontrolled and controlled epilepsy on the cognitive and behavioral development, quality of life and sleep of children and adolescents. Methods: Cross-sectional study comprising children and adolescents aged between 6 and 18 years, divided into three groups, uncontrolled epilepsy, controlled epilepsy and normal controls. Data were collected by reviewing medical records for allocation to groups. Uncontrolled subjects who had at least two monthly crises over three months prior to the study were included in the uncontrolled epilepsy group and subjects without seizures for at least six months were included in the controlled epilepsy group. In an interview with a neuropsychologist, the following tests were applied: the Wechsler Abbreviated Scale of Intelligence (WASI) to evaluate intellectual capacity; Child and Adolescent Behavior Inventory (CABI) for behavioral assessment; Quality of Life Questionnaire for children with epilepsy (QVCE50) to assess quality of life; and Children’s Sleep Habits Questionnaire to evaluate sleep characteristics. Results: The sample consisted of 70 patients, 33 males (47.1%) and 37 (52.9%) females whose average age was 12.2 years (standard deviation 3.2 years), all from a low socioeconomic class. Epilepsy group with uncontrolled seizures (n = 22), mean age 13.0 ± 3, 45.5% of females. Epilepsy group with controlled seizures (n = 18), mean age 12.3 ± 3.8, 22.2% of females. Control group (n = 30), mean age 11.5 ± 2.9, 76.7% of females. Patients in the control group had a mean IQ of 93.07, differing significantly from the epilepsy groups (P = <0.001). Patients with uncontrolled epilepsies had an IQ of 57.21, and those with controlled epilepsies showed an IQ of 61.44. The uncontrolled epilepsy group presented more behavioral problems when compared with the other groups. In the uncontrolled epilepsy group, there was a correlation between quality of life and onset of seizures (r = 0.58, P = 0.036) and epilepsy time (r = -0.60, P = 0.014). In the controlled epilepsy group, there was a correlation between the CBCL social competence score and epilepsy time (r = -0.62 P = 0.011). In both epilepsy groups there was a correlation between the CBCL total competence score and onset of seizures, r=0.55, P=0.029 in uncontrolled epilepsies and r=0.51, P=0.035 in controlled epilepsies, respectively. Sleep assessment showed a significantly worse quality in both epilepsy groups compared to healthy children. There was a significant difference in quality of life between the two epilepsy groups, the uncontrolled group showing a worse result. Conclusion: Epilepsies with uncontrolled seizures occurring in children and adolescents have a negative impact on several areas of development and on quality of life.