Executive function deficits among Malaysian children with epilepsy.

BACKGROUND

Children with epilepsy (CWE) are at risk of executive function (EF) deficits that may affect their behaviour, parenting stress and health related quality of life (HRQOL). This study aimed to i) determine the prevalence of EF deficits among Malaysian CWE and its associated factors, ii) explore the relationship between EF deficits, behaviour, parenting stress and HRQOL.

METHOD: Cross-sectional study of all mainstream school-going CWE seen at University Malaya Medical Centre, Kuala Lumpur from July 2023-January 2024. Children with learning disorders, neurodevelopmental disorders, or additional chronic medical conditions were excluded from the study. Questionnaires included the Behaviour Rating Inventory of Executive Function (BRIEF-2), Health Related QOL Measure for CWE (CHEQOL-25), Strengths and Difficulties Questionnaire (SDQ), and Parenting Stress Index-short form (PSI-SF) questionnaire.

RESULTS

Total of 115 participants (72 male) participated in the study with age range 6-18 years (mean 12.4 years). The prevalence of EF deficits ranged from 14.8 to 24.3% across different domains of BRIEF-2. The mean scores for BRIEF-2 scales were: Global Executive Composite (GEC) 56.1 (SD 9.57), Behaviour Regulating Index (BRI) 53.8 (SD 9.76), Emotion Regulation Index (ERI) 56.6 (SD 9.90) and Cognitive Regulation Index (CRI) 55.6 (SD 9.40). Multivariate logistic regression analysis identified hyperactivity/inattention as a significant factor for all domains of EF deficits, parent-child dysfunctional interaction (PCDI) for EF deficits in BRI and CRI subdomains and Chinese ethnicity for EF deficits in BRI and ERI subdomains. Scores from the hyperactivity/inattention domain of the SDQ were strongly correlated with GEC (r 0.73), BRI (r 0.64) and CRI (r 0.67) scores. Difficult child domain scores of the PSI-SF were moderately correlated with GEC scores (r 0.45). There was a significant but weak negative correlation between GEC scores and the total CHEQOL-25 scores (r - 0.24).

CONCLUSION

Twenty percent of Malaysian CWE were reported to have EF deficits. EF deficits were more prevalent among those with behavioural hyperactivity/inattention, Chinese ethnicity and elevated parenting stress levels. CWE with EF deficits were also at risk of lower HRQOL. Interventions for EF deficits should take into account ethnic differences, and address issues of associated behavioural problems and parenting stress.