Health-Related Quality of Life and Family Impact Among Children with Epilepsy: The Role of Seizure Control

Introduction: Seizure control is the primary therapeutic goal in pediatric epilepsy, yet its multidimensional impact on health-related quality of life (HRQoL) and family functioning remains insufficiently defined. This study examined the association between seizure control status and HRQoL in Chinese children with epilepsy, and explored correlates of seizure control. Methods: In this prospective questionnaire-based study, 191 children with epilepsy aged 4–18 years were enrolled after staged screening and classified into seizure-controlled (≥6 months seizure freedom; n = 146) and seizure-uncontrolled groups (n = 45). HRQoL was assessed using the Chinese version of the Quality of Life in Childhood Epilepsy Questionnaire-16 (QOLCE-16). Demographic, clinical, and family-related variables were collected. Group comparisons were conducted using appropriate statistical tests. Exploratory machine learning models were applied to identify factors associated with seizure control status. Results: Children in the seizure-controlled group had significantly higher QOLCE total raw scores, standardized scores, and social functioning scores than those in the seizure-uncontrolled group (all P < 0.05). No significant differences were observed in cognitive, emotional, or physical functioning domains. Family caregiving patterns and economic burden were largely comparable between groups. Machine learning models demonstrated modest performance; feature importance analyses identified age, emotional HRQoL, overall QOLCE scores, and caregiver education level as variables associated with seizure control. Conclusion: Sustained seizure control is associated with better overall HRQoL in children with epilepsy, particularly in social functioning, while other domains and family burden may persist beyond seizure status alone. These findings support integrated management strategies that address both seizure control and psychosocial well-being.