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Previous issue date: 2016-03-14 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / 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. / Introdu??o: O impacto cognitivo e comportamental das epilepsias que acometem crian?as e adolescentes tem forte relev?ncia cl?nica e ? influenciado por uma s?rie de fatores, tais como a idade de in?cio, a etiologia subjacente, a localiza??o do foco epileptog?nico e os efeitos das drogas antiepil?pticas em mono ou politerapia. O objetivo deste estudo foi avaliar o impacto da epilepsia n?o controlada e controlada no desenvolvimento cognitivo, comportamental, na qualidade de vida e do sono de crian?as e adolescentes. M?todos: Estudo transversal composto por crian?as e adolescentes com idade entre 6 e 18 anos, divididos em tr?s grupos, epilepsia n?o controlada, epilepsia controlada e controles normais. A coleta de dados foi realizada atrav?s de revis?o de prontu?rio para alocamento nos grupos. Foram inclu?dos no grupo das epilepsias n?o controladas sujeitos que apresentaram pelo menos duas crises mensais nos tr?s meses anteriores do estudo e no grupo das epilepsias controlada sujeitos com aus?ncia de crises h?, pelo menos, seis meses. Em entrevista com neuropsic?loga foram aplicados os seguintes testes: a Escala de Intelig?ncia Wechsler Abreviada (WASI), para avaliar capacidade intelectual; Invent?rio de Comportamentos da Inf?ncia e Adolesc?ncia (CBCL) para avalia??o comportamental; Question?rio de Qualidade de Vida para crian?as com epilepsia (QVCE50) para avalia??o da qualidade de vida; e Question?rio sobre h?bitos e qualidade de sono, para avaliar caracter?sticas do sono. Resultados: A amostra foi composta por70 pacientes, 33 do sexo masculino (47,1%) e 37 (52,9%) do sexo feminino, cuja m?dia de idade foi de 12,2 anos (desvio padr?o de 3,2 anos), todos de classe socioecon?mica baixa. Grupo com epilepsia com crise n?o controladas (n=22), m?dia de idade 13,0?3, 45,5% do sexo feminino. Grupo com epilepsia e crises controladas (n= 18), m?dia de idade 12,3?3,8, 22,2% do sexo feminino. Grupo-controle (n=30), m?dia de idade de 11,5?2,9, 76,7% do sexo feminino. Os pacientes do grupo-controle apresentaram m?dia de QI 93,07, diferindo de forma significativa dos grupos com epilepsia (p=<0,001). Os pacientes com epilepsias n?o controladas apresentaram QI 57,21 e os com epilepsias controladas QI 61,44.O grupo com epilepsias n?o controladas apresentou mais problemas comportamentais quando comparado aos outros grupos. No grupo de epilepsias n?o controladas houve correla??o entre qualidade de vida e in?cio das crises (r=0,58, P=0,036) e tempo de epilepsia (r=-0,60, P=0,014). No grupo de epilepsias controladas, houve correla??o entre a compet?ncia social do CBCL e o tempo de epilepsia (r=-0,62 P=0,011). Em ambos os grupos de epilepsia houve correla??o entre compet?ncia total do CBCL e o in?cio das crises, respectivamente r=0,55, P=0,029 nas n?o controladas e r=0,51, P=0,035nas controladas. A avalia??o do sono evidenciou de forma significativa pior qualidade em ambos os grupos com epilepsia quando comparados ao grupo de crian?as saud?veis. Houve diferen?a significativa na qualidade de vida entre os dois grupos de epilepsia, apresentando piora no grupo n?o controlado. Conclus?o: Epilepsias com crises n?o controladas que ocorrem em crian?as e adolescentes tem um impacto negativo em diversas ?reas do desenvolvimento e na qualidade de vida.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/6682 |
| Date | 14 March 2016 |
| Creators | Tisser, Luciana Alves |
| Contributors | Nunes, Magda Lahorgue |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 600, 600, 600, 600, -8624664729441623247, -969369452308786627, 2075167498588264571 |
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