Establishing clinical cutoffs for the PedsQL™ Epilepsy Module
Katherine W Junger1, Avani C Modi1, Shanna M Guilfoyle1
1Cincinnati Children's Hospital Medical Center, University of Cincinnati-College of Medicine, United States of America.
Insights
New clinical cutoffs for the PedsQL Epilepsy Module help identify children with epilepsy at risk for impaired quality of life. These scores aid in recognizing the impact of seizures, medications, and polytherapy on pediatric health.
Area of Science:
- Pediatric Neurology
- Quality of Life Research
- Clinical Psychology
Background:
- Health-related quality of life (HRQOL) is crucial for children with epilepsy (CWE).
- Existing tools may not fully capture the specific impacts of epilepsy and its treatment on HRQOL.
- Establishing clear clinical cutoffs can enhance the utility of HRQOL measures.
Purpose of the Study:
- To establish clinical cutoffs for the PedsQL Epilepsy Module scales.
- To dichotomize scores into normative or impaired categories.
- To identify youth at greater risk for HRQOL impairments due to seizures, antiepileptic drugs (AEDs), and polytherapy.
Main Methods:
- Recruited 237 youth (2-18 years) and caregivers from five US tertiary care hospitals.
- Administered PedsQL Epilepsy Module (parent/self-report) and caregiver-completed measures of behavior, mood, AED side effects, and executive functioning.
- Calculated clinical cutoffs using anchor-based (ROC curve) and distribution-based (0.5 SD) methods; analyzed differences based on seizure freedom, AED side effects, and polytherapy.
Main Results:
- Established clinical cutoffs for PedsQL Epilepsy Module subscales (Impact, Cognitive, Executive Functioning, Sleep, Mood/Behavior) for both parent and child reports.
- Youth experiencing more severe AED side effects, ongoing seizures, and/or polytherapy were significantly more likely to have impaired HRQOL across domains.
Conclusions:
- The established clinical cutoffs enhance the PedsQL Epilepsy Module's utility for surveillance of psychosocial comorbidities in youth with epilepsy (YWE).
- These cutoffs aid in tracking functional changes over time and inform clinical decision-making.
- Recommendations for additional assessment and intervention can be guided by these cutoffs for YWE.
Objective:
The purpose of the present study was to establish clinical cutoffs for the PedsQL Epilepsy Module scales by dichotomizing scores into normative or impaired. We predicted that these cutoffs would be useful in identifying children at greater risk for impairments in health-related quality of life (HRQOL) including those who exhibit effects of ongoing seizures, antiepileptic drugs (AEDs), and polytherapy.
Methods:
Two hundred and thirty-seven youth (2-18 years old) and their caregivers were recruited from five tertiary care hospitals across the United States. Caregivers and youth (5 years and older) completed the parent- or self-report versions of the PedsQL Epilepsy Module. Caregivers also completed measures of behavior and mood, AED side effects, and executive functioning in children. Clinical cutoffs were calculated in two ways: anchor-based (receiver operating characteristic (ROC) curve) and distribution-based (0.5 standard deviation (SD)). Medical characteristics were abstracted from the medical chart. t-Tests and chi-square tests were used to determine whether children's HRQOL classified as normative or impaired in epilepsy quality of life differed on seizure freedom, AED side effects, and polytherapy.
Results:
The final clinical cutoffs were as follows for each PedsQL Epilepsy Module subscale (caregiver and child): Impact (Parent = 60.7; Child = 64.39), Cognitive (Parent = 38.11; Child = 50.97), Executive Functioning (Parent = 46.65; Child = 57.15), Sleep (Parent = 42.07; Child = 43.90), and Mood/Behavior (Parent = 54.14; Child = 53.30). Youth with more severe AED side effects, ongoing seizures, and/or on polytherapy were more likely to have impaired quality of life across domains.
Conclusion:
Clinical cutoffs extend this instrument's utility in surveilling common psychosocial comorbidities, tracking changes in functioning over time, and informing clinical decision-making in youth with epilepsy including recommendations for additional assessment and intervention by a range of health providers serving youth with epilepsy (YWE).
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