The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."1 In the past, measures of success in treating medical illness have been thought of in terms of freedom of disease or identifiable quantifiable endpoints, such as serum glucose, systolic blood pressure, or seizures.2 However, recently, there has been an emergence of interest in measuring health-related quality of life (HRQOL), a valid and significant indicator of health in patients with disease. This idea has been studied over the past decade and applied to develop reliable and valid measures of function and well-being for use in patients with epilepsy.3 This concept especially pertains to chronic epilepsy, where though many treating clinicians focus on treating the ictal phenomenon of the disease, namely seizures, the disease itself carries a multitude of clinically relevant interictal comorbidities that affects patients' overall HRQOL.
Indeed, this concept is not specifically inclusive to adults, as the negative impact on quality of life in children is common, and typically manifests with impaired social functioning, peer relationships, self-esteem, mood, and academic performance.4,5,6,7 In addition, epilepsy can have a negative impact on not only the many aspects of a child's life but also on his or her family as well.6,8,9,10 Issues with subjective health status can be especially challenging for children living with epilepsy, because the maturation of a healthy self-identity is recognized as a fundamental task in a child's development.11
There has been increased focus concerning HRQOL and epilepsy in children over the past decade. Most of these studies used various standardized measures to systematically investigate the various aspects that contribute to HRQOL.12,13,14,15,16,17,18,19,20,21,22 However, many studies did not analyze qualitative measures, and were thus unsuccessful in investigating subjective health status by direct exploration of children's views.23
This review will examine the contribution and impact of different forms of comorbidity on overall health status in children in epilepsy. We will discuss neurpopsychiatric comorbidity, medication effects, seizure burden, and outcomes of epilepsy surgery pertaining to overall HRQOL.
IMPACT OF DEPRESSION IN CHILDREN WITH EPILEPSY
Depression is the most common comorbid psychiatric disorder in patients with epilepsy.24 Extensive literature has indicated that depression is a frequent complication of chronic epilepsy.25,26,27,28,29 However, symptoms of psychological distress are often unrecognized by clinicians treating children with epilepsy.28,29 There are a variety of potential causes of depression in children with epilepsy. For example, depression may be reactive and secondary to being diagnosed with a chronic, debilitating condition.30 Psychosocial factors, such as perceived social ...