Health behavior in teens with epilepsy: How do they compare with controls?

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Abstract

The goal of the study was to determine if adolescents with epilepsy have poorer health behavior than healthy controls. Health behavior was compared in two cohorts: cognitively normal teens aged 11–16 with epilepsy and similarly aged controls. Teens completed the Health Behaviour in School-Aged Children (HBSC) and Piers–Harris II, and the primary caregiver completed the Family Assessment Measure III. Forty-four teens with epilepsy and 119 orthopedic controls returned questionnaires. Adolescents with epilepsy had poorer health behavior than controls (P < 0.003). They felt significantly less positive about their health (P < 0.01) and were less physically active (P < 0.02). Poorer family function (P < 0.05) and lower self-esteem (P < 0.001) were predictors of poorer health behavior. Given the increased prevalence of comorbid diseases in adults with epilepsy, clinicians should routinely query teens with epilepsy regarding health behavior and provide anticipatory guidance and appropriate interventions for poor health behavior choices.

Introduction

Adolescence is a time of rapid psychosocial transition from childhood to an adult identity, and concerns regarding body image and being seen as normal are at their peak. Epilepsy during this time may significantly affect social development and maturation as a result of stigmatization and impaired independence, social function, peer relations, self-esteem, mood, and cognition [1].

Previous work has shown that teens with epilepsy suffer stress from uncontrolled seizures, limitation of leisure activities, side effects of medication, feelings of being different and stigmatized, and depression [1], [2]. Although one Swedish study reported a relationship between seizure severity and self-concept and attitude toward illness [3], another found that older adolescents reported poorer quality of life, more negative attitudes toward their epilepsy, and greater negative impact of epilepsy on general health and life, independent of epilepsy severity [4]. This negative view and poorer self-concept may impact on choices that teens make regarding their health, resulting in poorer health behaviors such as poor eating habits, less exercise, poor school attendance, increased risk-taking behaviors, drug, alcohol, and cigarette use, and riskier sexual behaviors. This may be especially important given the recent focus on somatic comorbidity in persons with epilepsy [5].

In this study, we used a validated health behavior questionnaire to compare health behavior in teens with epilepsy with that in controls, who were teens without chronic disease attending an outpatient orthopedic clinic. Choosing a comparison group without chronic disease is of importance as the goal for children with epilepsy would be to achieve normal health status comparable to that of children without disease and not to that of children with another underlying chronic disease. The orthopedic population represents an adequate comparison population as they would have exposure to the tertiary hospital experience (inpatient and/or outpatient), do not have chronic disease, do not have a condition that is stigmatized, and would provide enough of a population base to achieve recruitment of an adequate number of controls. This group allows for control of variables such as impact of exposure to the hospital environment and for determination of differences that may be related to having epilepsy, a chronic disease that is stigmatized. Although the control group may experience more injuries related to increased athletic activity, this cannot be inferred, as other populations, including persons with epilepsy, are much more likely than the general population to experience fractures [6].

Furthermore, we also evaluated the effects of self-esteem, family function, and epilepsy-related variables on health behavior. Low self-esteem in adolescents has been associated with compromising health behaviors and poor health in adulthood [7], [8], [9]. We were not specifically able to evaluate attitude toward illness, as our control group did not have chronic disease; however, given the previously reported positive correlation between self-esteem and attitude toward illness, we evaluated self-esteem [10]. Poor family function and abnormal family structure have been shown in various adolescent populations to impact health behaviors and have been correlated with increased tobacco and alcohol use, Internet addiction, and substance use [11], [12], [13], [14].

Section snippets

Identification of cohorts

Adolescents with epilepsy, aged 11–16 years, were identified through the Neurology Clinic Database. To meet entry criteria, teens had to be taking an antiepileptic medication and to have had two or more seizures, with at least one in the preceding year. They were excluded if they had another chronic disease or an estimated developmental quotient less than 80.

Orthopedic controls were similarly aged, had no history of active chronic disease, recurrent fractures, or attention deficit disorder, had

Results

Forty-four of 79 (56%) eligible teens with epilepsy and 119 of 154 (77%) eligible orthopedic controls returned completed questionnaires. The mean age of the cohort with epilepsy was 13.4 years, and that of healthy controls was 13.2 years. Demographic data are summarized in Table 1. The two groups were similar with respect to gender, family structure, family education, and socioeconomic status. Although adolescents with epilepsy had a higher mean body mass index score (21.5 ± 5.22) than controls

Discussion

Our study, to our knowledge, is the first to look specifically at overall health behavior in teens with epilepsy. We found that they had overall poorer health behavior than their peer group without epilepsy. Specifically, they felt significantly less positive about their health and got less exercise. They also showed trends toward poorer eating habits, poorer peer relations, and poorer interactions in the school environment.

The study of health behavior, particularly in the transitional period

Conclusions

Adolescents with epilepsy had poorer health behavior and felt less positive about their health compared with controls. Given the increased prevalence of comorbid diseases in adults with epilepsy, clinicians should routinely query teens with epilepsy regarding health behavior and provide anticipatory guidance and appropriate interventions for poor health behavior choices. It is important for health professionals and caregivers to promote healthy behaviors and recognize comorbid conditions, and

Acknowledgments

The authors would like to thank Dr Alberto Nettel-Aguirre for assisting in the statistical analysis. The authors would also like to thank Dr William Boyce for permission to use the Health Behavior in School Aged Children Questionnaire.

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