Abstracts

Rationale: Patients with epilepsy often experience acute repetitive seizures, or seizure clusters. Clusters impact several aspects of a patient’s life, including their physical, emotional, and social wellbeing. We aim to investigate the effect of seizure clusters on health-related quality of life in pediatric epilepsy patients. Methods: This was a retrospective study of baseline data obtained in an ongoing prospective observational study conducted at two tertiary epilepsy centers. Patients 1 month to 18 years old with a documented diagnosis of epilepsy were enrolled at two tertiary epilepsy centers. Those with psychogenic/non-epileptic seizures, epileptic spasms, or very high baseline frequency of seizures (more than one seizure per hour) were excluded. Investigators defined clusters as two or more seizures in 24 hours (day clusters). Patients were categorized into three groups based on their reported seizure frequency in the year prior to enrollment: 1- “Prior clusters”: Patients reporting at least one seizure cluster, 2- “Active epilepsy”: patients reporting seizures but without clustering, and 3- “Seizure Free”: patients who were seizure free during the prior year. Quality of life was measured using the Quality of Life in Children with Epilepsy-55 (QOLCE-55) for children ages 4-11 years, and the Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48) for patients 12-18 years old. Results: Of the 251 patients enrolled, 53.8% were female, and the median age was 10 years old (IQR: 7-14) (Table 1). During the year prior to the presentation, 86 patients (34.3%) had experienced seizure clusters, while 86 (34.3 %) had seizures without clusters, and 79 (31.4 %) were seizure free. 73 patients completed the QOLCE-55 questionnaire and 45 completed the QOLIE-AD-48. The mean score was 62.5 (95% CI 57.9-67.2) for QOLCE-55 and 68.5 (95% CI 65.0-72.0) for QOLIE-AD-48. Patients in the prior clusters group had a mean score of 52.6 (95% CI 45.5-59.7), which was lower compared to 69.3 (95% CI 60.8-77.8) in patients with active epilepsy but no clusters, and 72.1 (95% CI 65.6-78.6) in the seizure free group (Kruskal-Wallis test, ?2(2) = 15.9, p < 0.001), (Table 2). A multivariate regression found this difference in means to be significant even when adjusted for reported monthly seizure frequency (p < 0.001). There was no difference in the mean QOLIE-AD-48 score between the three risk groups (?2(2) = 2.83, p =0.24). While seizure free adolescents reported the highest quality of life (71.6, 95% CI 67.8-75.3), cluster patients scored similarly (70.7, 95% CI 60.5-80.9). Conclusions: Patients 4-11 years old with seizure clusters exhibited a lower overall quality-of-life score compared to those in the same age group with active epilepsy without clustering, as well as compared to the seizure-free patients. If this difference is reproducible, the possibility of improved coping skills in adolescence versus other factors may shed light on aspects of monitoring, management, and prognosis of patients with acute repetitive seizures. Funding: This study was supported by Upsher-Smith Laboratories.