Professor Special Lecture 75th Annual Meeting of the Medical Society of Toho University QOL-Related Factors in Childhood Epilepsy

Quality of life (QOL) in childhood epilepsy is associated with clinical and social variables. Among these variables, seizure frequency has been identified as the important predictor of QOL. Additionally, frequency of interictal epileptiform discharges (IEDs) on electroencephalogram (EEG) may accompany transient cognitive/behavioral impairments. Moreover, seizure frequency and/or IEDs may play a role as a mediator of emotional responses including stigma and fatigue in childhood epilepsy. Hence, seizure frequency and/or IEDs are one of the important QOL-related factors in childhood epilepsy. Frontal lobe dysfunctions such as cognitive and behavioral problems can be associated with the reduction in QOL for both child himself and his/her family. Serial three-dimensional MRI studies revealed the frontal/prefrontal lobe growth disturbance during the active phase of epilepsy in some children with neuropsychological problems. Moreover, prefrontal lobe growth showed rapid recovery in epilepsy patients with a shorter active seizure period. These findings suggest that frequent seizures may lead to prefrontal lobe growth disturbance, which relates to neuropsychological problems in children with epilepsy. Furthermore, frequent seizures may be associated with seizure-associated headaches, stigma, parental stigma, and fatigue. Additionally, among IEDs on EEG, which may correlate with persistent pathological neuronal discharges, frontal IEDs may be at risk for seizure recurrence and cognitive/behavioral impairments and may play a role as a mediator of emotional responses including stigma. Moreover, behavioral problems may be associated with secondary bilateral synchrony (SBS) on EEG. There may be a possibility that behavioral impairments will be improved in association with EEG improvement in patients presenting with frontal IED and SBS. Hence, seizure severities and IEDs on EEG may be associated with neuropsychological problems, which relates to the reduction in QOL. The preferable treatment strategy may be required to remit seizures and EEG abnormalities as soon as possible to accomplish the most favorable prognosis for children with epilepsy.