Evaluation of a self-regulation based psycho-educational pilot intervention targeting children and adolescents with epilepsy in Greece.

PURPOSE: The purpose of this study is to describe the development and initial evaluation of a minimal structured psycho-educational intervention for children and adolescents with epilepsy. The intervention aimed at increasing the understanding and personal control (self-management) of epilepsy, and at reducing psychological distress, sleep problems and somatic complaints. METHOD: Twelve patients participated in our intervention and another 12, matched on age and gender, served as the control group. Data were obtained at baseline (prior to the intervention) and 3 months later in the context of an interview based on several validated questionnaires. The intervention was limited to one 4-h session using Cognitive Behavioural Therapy techniques, relaxation techniques, video and storytelling. Effects of the intervention on primary and secondary outcomes were examined using 2 (baseline, T1 vs. post-treatment, T2)×2 (intervention vs. control) mixed model repeated measures analysis of covariance (ANCOVA), controlling for epilepsy severity. RESULTS: The analysis revealed that over the three months of the study, significant main effects (group x time) were observed on coherence (F(1,21)=6.12; p=0.02) with important changes in favour of the intervention group. Significant main effects were also observed on psychological distress levels (F(1,21)=10.08; p=0.005) and sleep problems (F(1,21)=11.40; p=0.003). CONCLUSION: The results of this study show that a brief self-regulation-based intervention may have beneficial effects for children and adolescents suffering from epilepsy by inciting improvements in coherence, psychological distress and sleep problems.

The contribution of illness perceptions to fatigue and sleep problems in youngsters with epilepsy.

PURPOSE: The present study aims to explore the extent to which gender, epilepsy severity and illness perceptions predict fatigue and sleep problems in youngsters with epilepsy. METHOD: Structured interviews were conducted in 100 young patients (Mage = 13,9, SD = 2.21; 41% girls) and data were analyzed by means of multiple hierarchical regression analyses. RESULTS: Most patients (91%) were well controlled by anti-epileptics; 3% had infrequent seizures and 6% were pharmacoresistant. At a multivariate level it appeared that youngsters with epilepsy who believe that they have less personal control over their illness and who feel that the illness has a high emotional impact on their lives reported higher levels of fatigue. In addition, more sleep problems were reported by youngsters who think they have less personal control over the disease, who believe that treatment controls epilepsy and report that the disease has a high emotional impact on their lives. CONCLUSION: Given the importance of illness perceptions, it is suggested that they are targets for future interventions that aim to reduce fatigue and sleep problems in youngsters with epilepsy.

Illness perceptions determine psychological distress and quality of life in youngsters with epilepsy.

The aim of this cross-sectional study was to explore the extent to which gender, epilepsy severity, and self-regulation concepts (illness perceptions, autonomous treatment regulation, perceived autonomy support by parents) predict psychological distress and quality of life (QoL) in young patients with epilepsy. Structured interviews were conducted in 100 patients (Mage=13.9, SD=2.21, 41% girls), and data were analyzed by means of multiple hierarchical regression analyses. Seizures of most patients (91%) were well controlled by antiepileptics, 3% of the patients had infrequent seizures, and seizures in 6% were pharmacoresistant. At a multivariate level, it appeared that youngsters with epilepsy who expect that their disease will last for a long time, who believe that they have less personal control over their illness, and who expect the illness to have a high emotional impact reported higher levels of distress. In addition, a better QoL was reported by youngsters who believed that treatment did not control their illness and who thought that their epilepsy would not affect them emotionally. Findings indicate the importance of illness perceptions, and it is suggested that they should be targeted in future interventions in youngsters with epilepsy.

Botulinum toxin treatment in upper limb spasticity: treatment consistency.

This study assessed treatment consistency of botulinum toxin administration in spastic upper limbs under pragmatic conditions, as derived through stability of dosages and between injections intervals. Over a period of 8 years, 153 children (81 with bilateral spastic cerebral palsy, 72 with unilateral) were treated according to accepted, experience-based guidelines with Botox and Dysport. Treatment response was based on assessment of spasticity and attainment of pre-determined goals at 3, 6 and 12 months post each treatment. Mean age at treatment onset was 6y 4mo (SD: 4y 10mo), median F/U, 2.5 years (4 months-6 8/12 years). Number of injection sessions was 1-10; few had more than 6 sessions. In 106 (69.28%) children, more than one anatomic regions of the limb were injected. Most (56.2%), had at least two injection sessions; median time interval between the sessions was 9 months (IQR: 4-35 months, similar for unilateral and bilateral cerebral palsy, p = 0.874). Children >4 years old at the first treatment had longer intervals between sessions (25.8%) compared to younger ones (p = 0.010). The mixed effects models demonstrated that botulinum toxin dosage was stable over subsequent visits (p = 0.144) and that intermediate intervals for subsequent visits were similar to the first one (p = 0.279).

Effects of psycho-educational training and stimulant medication on visual perceptual skills in children with attention deficit hyperactivity disorder.

UNLABELLED: Attention deficit hyperactivity disorder (ADHD) is treated with stimulants and psycho-educational remedial programs despite limited literature support for the latter. This study aimed to examine changes in a "Test of Visual Perceptual Skills" (TVPS) that has not been previously reported in children with ADHD enrolled in such a program. METHODS: Sixteen children, 7-11 years old, with ADHD were involved in occupational therapy and special education geared towards attention training. Six months later methylphenidate 1 mg/kg/day was prescribed. It was not taken by eight children because of family choice. The TVPS was given twice, upon diagnosis, and 8 months post-intervention. The groups were compared by a repeated measures analysis of variance (ANOVA) with medication as a between groups factor and test-retest scores as within factor. RESULTS: All children demonstrated increases in total scores in the second measurement. Medicated children scored higher but ANOVA showed a nonsignificant F for the two groups, medicated and unmedicated (F = 0.0031, p = 0.9563), indicating a nondifferential effect of the two levels of treatment. It revealed a significant F for the pre- and post-treatment total TVPS scores (F = 30.91, p < 0.0001) indicating a significant difference between pre- and post-treatment tests. The interaction between pre-post treatment and level of treatment (medicated-unmedicated) was nonsignificant (F = 2.20, p = 0.1604). CONCLUSION: TVPS scores improved in all children following intervention. Medicated children did better, but differences were nonsignificant.