Abstracts

Rationale: The impact of family environment on cognition has been assessed in the general population but has not been adequately addressed in pediatric epilepsy. This study aims to evaluate whether family related variables were associated with intellectual functioning among children with medically refractory epilepsy, and whether family related variables moderate the relationship between patient and epilepsy related variables and intellectual functioning. Methods: One hundred children aged 4 to 18 years with medically refractory epilepsy who were evaluated for surgical candidacy were recruited. We assessed the association of intelligence quotient (IQ) with patient, epilepsy and family related variables. Family related variables included parental education, household income, and validated parent-report measures of family functioning, family mastery and social support, and family demands. Results: Univariate analyses showed that higher IQ scores were associated with an older age of epilepsy onset (߽.260, p=.009), fewer AEDs (߽.248, p=.013), a shorter duration (߽.384, p < .001) and percentage of life with epilepsy (߽.419, p < .001), unilobar epileptogenic foci relative to multilobar foci (߽.274, p=.006), and lower family demands (߽.211, p=.035). In multivariate analysis, unilobar epileptogenic foci (p=.010) and a shorter percentage of life with epilepsy (p=.001) remained significant predictors of IQ. The relationship between the extent of epileptogenic foci and IQ was moderated by family demands (p=.004); specifically, patients with unilobar epileptogenic onset had similar IQ scores irrespectively of family demands, whereas patients with multilobar foci had lower IQ scores with increasing family demands. Conclusions: Family environment moderated the relation between epilepsy related variables and IQ among children with medically refractory epilepsy. Poor family environment may be amendable to intervention and may allow for a new avenue in improving cognitive functioning in children with epilepsy. Funding: Supported by a research grant from the Canadian Institutes of Health Research.