Determinants of health-related quality of life in pediatric epilepsy: the impact of treatment tolerability and epilepsy type.

BACKGROUND: Health-related quality-of-life (HRQOL) is a central outcome in pediatric epilepsy, yet the relative influence of disease severity versus treatment-related burden remains unclear. This study aimed to evaluate HRQOL and assess the respective contributions of clinical characteristics and treatment adverse events in children with epilepsy. METHODS: A cross-sectional analysis of 101 children enrolled in a prospective cohort in Lebanon was conducted. HRQOL was assessed using the Arabic QOLCE-55, and treatment-related adverse effects were measured using the Liverpool Adverse Events Profile (LAEP). Multivariable linear regression models, including hierarchical domain-specific analyses, were used to identify factors independently associated with HRQOL. RESULTS: HRQOL was moderately reduced, with a median QOLCE-55 score of 66 (IQR 55.68-79.41). The physical domain was the most affected (44.44; IQR 30.55-59.72), while the social domain was the least impaired (82.14; IQR 67.85-96.42). In multivariable analysis, higher adverse-effect burden was the strongest factor associated with poorer overall HRQOL (B = -0.97, 95% CI -1.28 to -0.67; p < 0.001), whereas most seizure-related variables were not significant after adjustment. Inclusion of LAEP substantially improved model performance (ΔR 2 up to 0.310) and was associated with poorer HRQOL across all domains. Longer epilepsy duration remained associated with poorer physical HRQOL, and focal epilepsy with lower social and emotional scores. CONCLUSION: In this cohort, HRQOL was more strongly associated with treatment-related adverse effects than with most seizure-related variables. Treatment tolerability appears to represent an important and modifiable correlate of well-being. Routine assessment of adverse effects may enhance patient-centered care.