SUMMARYThe impact of epilepsy is not limited to the child experiencing seizures, but affects all members of the family. As primary caregivers, mothers are particularly at risk for experiencing increased depressive symptoms and risk for clinical depression. The objective of this systematic review was to critically assess available evidence regarding the prevalence, associated factors, and impact of maternal depressive symptoms on child outcomes in epilepsy. Using a modified version of the Quality Index, studies were rigorously evaluated in terms of reporting, external validity, and internal validity. Limitations in the study designs and analytic techniques of previous research are discussed, and study methods to overcome these barriers are presented in order to advance this research area. Up to 50% of mothers of children with epilepsy are at risk for clinical depression. Correlates of maternal depressive symptoms include a number of modifiable risk factors such as role ambiguity, worry, and satisfaction with relationships. In addition, studies suggest that depressive symptoms in mothers have a negative impact on child outcomes in epilepsy including behavior problems and health-related quality of life. The overall mean score on the Quality Index was 9.7, indicating a midrange quality score, suggesting a need for more methodologically robust studies.

Objectives:To assess health-related quality of life (HRQL) over 2 years in children 4Ϫ12 years old with new-onset epilepsy and risk factors.Methods: Data are from a multicenter prospective cohort study, the Health-Related Quality of Life Study in Children with Epilepsy Study (HERQULES). Parents reported on children's HRQL and family factors and neurologists on clinical characteristics 4 times. Mean subscale and summary scores were computed for HRQL. Individual growth curve models identified trajectories of change in HRQL scores. Multiple regression identified baseline risk factors for HRQL 2 years later.Results: A total of 374 (82%) questionnaires were returned postdiagnosis and 283 (62%) of eligible parents completed all 4. Growth rates for HRQL summary scores were most rapid during the first 6 months and then stabilized. About one-half experienced clinically meaningful improvements in HRQL, one-third maintained their same level, and one-fifth declined. Compared with the general population, at 2 years our sample scored significantly lower on one-third of CHQ subscales and the psychosocial summary. After controlling for baseline HRQL, cognitive problems, poor family functioning, and high family demands were risk factors for poor HRQL 2 years later. Conclusions:On average, HRQL was relatively good but with highly variable individual trajectories. At least one-half did not experience clinically meaningful improvements or declined over 2 years. Cognitive problems were the strongest risk factor for compromised HRQL 2 years after diagnosis and may be largely responsible for declines in the HRQL of children newly diagnosed with epilepsy. Neurology The primary goal in managing epilepsy is to optimize patients' health-related quality of life (HRQL) by affording them a lifestyle as free as possible from the medical and psychosocial sequelae of seizures.1,2 Empirical evidence of the natural course of HRQL and associated risk factors is an essential step toward providing prognostic information to patients and families and determining key factors along the causal pathway that may be amenable to interventions to mute the potential negative effects of epilepsy on HRQL. Most empirical assessments of HRQL in children with epilepsy (CWE) have focused on a specific aspect of HRQL (e.g., psychological well-being, social competence, or behavior). Of the comprehensive, multidimensional assessments of HRQL in children, most had small samples and focused on selected subgroups such as adolescents, 3,4 children with intractable/refractory epilepsy, 5,6 or childrenFrom the