Abstracts

Rationale: Children with drug-resistant epilepsy (DRE) often experience psychiatric symptoms and executive functioning challenges, including difficulty with emotional control, planning and organization, as well as symptoms of depression and anxiety. Although common, these concerns are not consistently assessed in clinical settings, and the link between executive function and behavioral outcomes in pediatric epilepsy remains underexplored. At our institution, universal behavioral assessments were implemented during presurgical evaluations in the epilepsy monitoring unit to screen for psychiatric symptoms (BASC-3) and quality of life (QoL). This study extends that work by examining how executive function, as measured by the BRIEF, relates to depression and anxiety—and whether these domains predict QoL in youth with DRE.

Methods: From January 1 to December 31, 2024, all patients admitted to the EMU underwent standardized behavioral assessments, regardless of clinical concern, as part of the Pediatric Epilepsy Research Consortium (PERC) surgery database project. Measures included the BASC-3 for psychiatric symptoms, BRIEF for executive function, and Pediatric Quality of Life Inventory (PedsQL). Forty-eight guardians completed all three. BASC-3 T-scores for depression and anxiety were categorized using standard clinical cutoffs ( >60 = at-risk; >70 = clinically significant). BRIEF subscale T-scores were recorded for Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor, plus composite scores for the Global Executive Composite (GEC), Behavioral Regulation Index (BRI), and Metacognition Index (MI). Regression analyses examined relationships among executive function, psychiatric symptoms, and QoL.

Results: Emotional control was the strongest predictor of depressive symptoms (R² = 0.512, p < .001). Behavioral regulation, working memory, and monitoring also showed moderate associations (R² = 0.26–0.30, all p < .001). For anxiety, planning/organization was the strongest predictor (R² = 0.21, p < .001), followed by working memory, initiation, and monitoring (R² = 0.15–0.19, all p < .01). For QoL, initiation was the strongest predictor (R² = 0.370, p < .001), followed by planning/organization and behavioral regulation (R² = 0.27–0.30, all p < .001). Additional domains—including emotional control, metacognition, and shift—were moderately linked to QoL (R² = 0.21–0.26, p < .01). Depression and anxiety were also independently associated with lower QoL (R² = 0.158 and 0.113, p < .001 and p < .009, respectively).