The role of executive functioning in quality of life in pediatric intractable epilepsy

•Children with intractable epilepsy show dysfunction in everyday executive function.•Poor executive skills are not due to seizure lateralization and localization.•Executive functions accounted for significant variance in overall quality of life.•Executive dysfunction is associated with a nine-fold risk of low quality of life.

ObjectiveChildren with epilepsy are vulnerable to executive dysfunction, but the relationship between executive functioning (EF) and quality of life (QOL) in children with epilepsy is not fully delineated. This exploratory study elucidated the relationship between ecological EF and QOL in pediatric intractable epilepsy.MethodFifty-four consecutively referred pediatric epilepsy surgery candidates and their parents were administered IQ measures, the Behavior Rating Inventory of Executive Function (BRIEF), and the Quality of Life in Childhood Epilepsy (QOLCE) as part of a comprehensive neuropsychological evaluation.ResultsA significant difference was found in QOL between those with and without clinical impairments on the BRIEF [t(52) = 3.93; p < .001]. That is, children with executive dysfunction had lower overall QOL. All seizure variables and BRIEF scales were associated with overall QOL [F(12, 40) = 6.508; p = .001; R2 = .661]. Working memory from the BRIEF was the most frequently elevated scale in our sample (57%). Those with executive dysfunction had 9.7 times the risk of having poor QOL.ConclusionsPoor EF control according to behavior ratings is significantly related to QOL in intractable pediatric epilepsy. Identification of executive dysfunction in home environments is an essential component of presurgical evaluations and target for intervention, which may improve QOL.