Elsevier

Epilepsy & Behavior

Volume 8, Issue 3, May 2006, Pages 547-551
Epilepsy & Behavior

Quality of life in medication-resistant epilepsy: The effects of patient’s age, age at seizure onset, and disease duration

https://doi.org/10.1016/j.yebeh.2006.01.001Get rights and content

Abstract

Objective

The goal of this study was to examine the effects of age, age at seizure onset, and duration of epilepsy on health-related quality of life (HRQOL) in patients with medication-resistant epilepsy.

Methods

We analyzed data for a sample of 99 patients with medication-resistant epilepsy drawn from admissions to the Epilepsy Monitoring Unit. Patients had completed the Quality of Life in Epilepsy—89 (QOLIE-89), Profile of Mood States (POMS), and Adverse Events Profile. Number of comorbidities and number of antiepileptic drugs were abstracted from the chart. The dependent variable was QOLIE-89 overall score. The data were analyzed using ordinary least-squares regression.

Results

The simple regression results showed no significant effect of patient’s age on QOLIE-89 (P = 0.354), whereas age at onset and duration had significant effects (P = 0.004 and P = 0.012, respectively); the higher the age at onset and the shorter the disease duration, the lower the HRQOL. After adding POMS Depression/Dejection, Adverse Events Profile, comorbidities, and antiepileptic drugs, the effects of age at onset and duration were no longer significant (P = 0.084 and P = 0.207).

Conclusions

Adult-onset epilepsy can disrupt one’s established social, economic, and psychological life, while better coping mechanisms and social support may improve HRQOL as the duration of epilepsy increases. The modest association of age at onset and disease duration with HRQOL is explained away by mood states and adverse events, which are much stronger predictors of HRQOL. Interventions to improve HRQOL in patients with medication-resistant epilepsy should, therefore, focus on treating mood disturbances and minimizing medication side effects.

Introduction

Epilepsy is well-known to have detrimental effects on quality of life [1], [2], [3], [4]. Patients with epilepsy endure driving restrictions and social stigma, they often fear their next seizure, and they are exposed to adverse medication side effects. All of those factors contribute to impaired health-related quality of life (HRQOL) [1], [2], [3], [4], [5], [6], [7], [8], [9]. Interest in the effects of epilepsy on HRQOL has led to the development of epilepsy-specific quality-of-life instruments, which have been validated and subsequently widely used to measure response to treatment, as well as to assess risk factors for poor quality of life in patients with epilepsy. Seizure frequency, medical and psychiatric comorbidities, number of antiepileptic drugs (AEDs), and medication side effects have all been correlated with lower HRQOL [1], [3], [5], [9], [10], [11], [12], [13], [14], [15], [16]. Age-related morbidity, particularly duration of epilepsy and age at onset, have been noted to affect quality of life in secondary analysis in certain subgroups of epilepsy patients, e.g., adolescents, but few studies have explored the direct effect of age [17], [18], and none have tested and compared the effects of age, age at seizure onset, and disease duration on HRQOL. In this study, we examine these three types of age-related effects on HRQOL in a sample of patients with medication-resistant epilepsy. Among people with epilepsy, those suffering from recurring seizures despite medical treatment are known to have an especially low HRQOL [4]. Understanding the factors associated with HRQOL in this patient population is necessary to design appropriate interventions.

Section snippets

Methods

We collected data on patients admitted to the Epilepsy Monitoring Unit (EMU) of the University of Cincinnati between January 20, 2001 and January 20, 2003. Many patients with medication-resistant epilepsy undergo video/EEG monitoring as part of their clinical management, and so an epilepsy monitoring center is a logical site at which to study this patient population. On admission, the patients completed an epilepsy-specific quality-of-life instrument, the Quality of Life in Epilepsy—89

Results

Of 101 patients eligible for the analysis, 13 patients (13%) did not complete POMS and/or Adverse Events Profile. Based on a missing data analysis,

Discussion

This study attempts to elucidate the role of age, age at seizure onset, and seizure duration on HRQOL in epilepsy. The findings show that although age is not a significant correlate of quality of life in epilepsy, age at onset and duration of epilepsy can be expected to have significant associations with quality of life in epilepsy—if no other known correlates of QOLIE-89 are considered. However, when additional data, especially those regarding depression and adverse events, are available, they

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    This work was presented in part at the annual meeting of the American Epilepsy Society, Boston, MA, 2003.

    1

    These authors contributed equally to this work.

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