Impact of number of anti-seizure medications on long-term health-related quality of life in children with epilepsy: A prospective cohort study

Purpose: Health-related quality of life (HRQL) is compromised in children with epilepsy. We aimed to determine whether children diagnosed with epilepsy between ages 4-12 years who are exposed to a higher number of anti-seizure medication (ASM) over the first 2 years, have poorer HRQL 10 years after diagnosis. Methods: Data were obtained from 195 children enrolled in the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES) in Canada. HRQL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) completed by parents at baseline through to 10 years after diagnosis. The total number of ASM were reported by physicians four times in the first two years after diagnosis. Multivariable block-wise linear regression was used to assess the impact of ASM (categorized as none, one, or more than one), as well as clinical and family factors on children's HRQL 10 years after diagnosis. Results: Children had a mean age of 7.9 +/- 2.3 years at diagnosis and 92 (47%) were female. Mean QOLCE at baseline and 10 years was 72.04 +/- 14 and 78.7 +/- 16,respectively. Clinically meaningful improvement in HRQL from the 2 to 10-year follow-up was detected in 35% of children, reported similarly across all ASM treatment categories (p = .38). The number of ASM prescribed in the first two years was associated with HRQL at the 10-year follow-up, however this association was not significant when adjusting for clinical characteristics, family factors, and HRQL at the two-year follow-up (p = .75). Our data showed that HRQL at 2 years was the only variable associated with better HRQL scores at 10 years (p = <.001). Conclusion: In children with new onset epilepsy, exposure to a higher number of ASM, when accounting for clinical and family factors as well as HRQL at 2 years, is not independently associated with lower long-term HRQL. Early HRQL was found to be a good indicator of long-term HRQL, despite the number of ASMs prescribed.