Sleep and functional outcomes in children and adolescents with epilepsy: A scoping review.

AIM: In children and adolescents with epilepsy (CAWE), disturbed sleep and functional difficulties are frequently present, but their relationship is unclear. In this scoping review we aimed to explore associations between sleep and functional outcomes in CAWE. METHOD: We registered the protocol with open science framework and conducted the review according to the PRISMA Extension for Scoping Reviews. We searched Medline, Embase, PsycINFO and PubMed for original studies reporting on relations between sleep and functional outcomes (adaptive/quality of life, behavioural/mood, cognitive & academic) in CAWE. To assess the quality of studies we used an extended version of the checklist employed by Winsor and colleagues [1]. RESULTS: We identified 14 studies that included 1,785 CAWE and 1,260 control children, with a mean age of 9.94 and 10.13 years, respectively. The studies were highly heterogeneous with respect to samples, epilepsy variables, and methods used to assess sleep and functional outcomes. The quality of studies was medium. Associations between sleep and adaptive/quality of life, behavioural/mood, cognitive and academic outcomes were examined in 2, 10, 6, and 0 studies, respectively. Across studies, in CAWE, greater sleep disturbances were related to worse behavioural/mood outcomes, ranging from depression/anxiety to ADHD symptoms. Sleep disturbances did not consistently relate to cognitive outcomes, but they related to worse adaptive outcomes in both studies that examined their relationship. CONCLUSIONS: Our study provides evidence of relationship between disturbed sleep and behavioural/mood difficulties, which alerts to the need for careful evaluation and treatment of sleep disturbances in CAWE. Our study also highlights the need to examine relationships between sleep and other functional outcomes in CAWE, as studies conducted in the general population suggest that sleep disturbances may be modifiable and associated with improved functional outcomes.

Factors that predict discharge recommendations following paediatric mild traumatic brain injury.

PRIMARY OBJECTIVE: To investigate factors that predict discharge recommendations for children and adolescents who present to an Australian paediatric Emergency Department (ED) following a mild traumatic brain injury (mTBI). RESEARCH DESIGN: Retrospective data base analysis. METHODS: The study retrospectively analysed an ED database to test the relationship between injury risk factors (symptoms, Glasgow Coma Scale, prior TBI, mechanism of injury and Computed Tomography scan), non-injury risk factors (sex, age, socio-economic status (SES)) and discharge recommendations of 2807 children and adolescents (0-18 years) who presented to a children's hospital ED over a three year period with mTBI. RESULTS: Univariate analyses indicated a statistically significant association of discharge recommendations with age, SES, mechanism of injury and vomiting. However, multivariate analyses indicated vomiting and mechanism of injury were the only statistically significant risk factor associated with discharge recommendations, when controlling for other risk factors. CONCLUSIONS: The current study suggests vomiting and mechanism of injury are the only risk factors predicting discharge recommendations for children and adolescents with mTBI.

Parental cognitive appraisals and coping behaviours following child's epilepsy diagnosis: a qualitative study.

Management of childhood epilepsy places significant demands and increased stress on the family unit. How parents adjust to this illness-related stress is believed to be shaped by their cognitive appraisals of the situation and the coping behaviours that are employed (Wallander & Varni, 1992). We investigated the cognitive and behavioural strategies that regulated psychological symptomatology in mothers following an epilepsy diagnosis of their child. Twenty-one mothers participated in this qualitative study. Interview data was analyzed using theory-driven thematic analysis. The analysis revealed common effective cognitive appraisals that include maintaining a positive outlook, re-structuring expectations and finding meaning from their experiences. Problem-solving, emotional venting, time to self and speaking with parents in similar situations were behaviours that buffered against carer strain. The coping strategies identified in this study can be seen as sources of resilience and therefore provide a guide for improving parent outcomes in the context of pediatric illness. Implications for clinical services are discussed in this paper.