Elsevier

Epilepsy & Behavior

Volume 16, Issue 2, October 2009, Pages 325-329
Epilepsy & Behavior

Seizure severity is associated with quality of life independent of seizure frequency

https://doi.org/10.1016/j.yebeh.2009.07.037Get rights and content

Abstract

Objective

The goal of the work described here was to determine whether seizure severity is associated with quality of life and if this association exists independent of seizure frequency.

Methods

We administered a survey questionnaire to patients followed at the Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville.

Results

The study population comprised 142 subjects. On univariate analysis, increased seizure severity (as measured with the revised Liverpool Seizure Severity Scale, LSSS) and seizure frequency were significantly associated with poorer Quality of Life in Epilepsy-10 (QOLIE-10) scores. Most items on the LSSS were significantly associated with QOLIE-10 scores, as well as the various scales of the QOLIE-10. Likewise, all QOLIE-10 scales were significantly associated with overall LSSS scores. The correlation between seizure severity and frequency was insignificant. On multiple linear regression, both seizure severity and frequency were independently associated with QOLIE-10 scores.

Conclusion

Seizure severity is associated with quality of life and this association exists independent of seizure frequency.

Introduction

Improved seizure frequency and quality of life are generally regarded as the primary outcomes of epilepsy care. It is well established that decreasing seizure frequency positively impacts quality of life [1], [2], [3], [4], [5], [6]. However, seizures in around 20% of patients with epilepsy are refractory to existing therapies [7]. In these individuals, other indices of therapeutic outcome, such as measuring the changes in seizure severity as a result of medication therapy, might be a useful index of care. Seizure severity has been shown to strongly correlate with psychological measures such as self-esteem [8]. However, measurement of seizure severity has not been generally used in clinical practice to determine the outcome of epilepsy care.

It is important to establish whether seizure severity should be considered a primary outcome of epilepsy care. It is also important to know whether changes in seizure severity and frequency correlate with one another. One method to assess this would be to determine the effects of seizure severity on quality of life.

In this study, our aims were to determine the association between seizure severity and quality of life in a group of individuals with epilepsy being followed at a tertiary epilepsy center and to determine whether this association exists independent of seizure frequency.

Section snippets

Methods

The institutional review board of the University of Florida Health Sciences Center/Jacksonville (UFHSCJ) and Shands Hospital, Jacksonville, approved the study protocol. The UFHSCJ Comprehensive Epilepsy Program (CEP) is a tertiary (level 4) center that serves as a major referral center for northeast Florida and southeast Georgia. Forty-two percent of patients seen at UFHSCJ-CEP are male; 58% are Caucasian and 31% African-American. Approximately 40% of patients are part of the city’s indigent

Results

One hundred forty-two patients participated in the study. The demographic information is summarized in Table 1. The mean age of our subjects was 38 years, and 44% were male. The majority of subjects were single (58%) and Caucasian (63%). Around 70% of subjects had less than a college education. More than 14% of subjects had daily seizures, and only 1% had fewer than one seizure a year. The mean LSSS score was 51. Only 127 patients completed all 10 items of the QOLIE-10 and had their overall

Discussion

Our study indicates that increased seizure frequency and severity are both associated with poorer quality of life among patients with epilepsy, independent of one other.

The association between seizure frequency and quality of life has long been established [1], [2], [3], [4], [5], [6]. Though not as well studied, the association between seizure severity and quality of life has also been reported. Harden and colleagues [11] found that even when controlling for depression, seizure severity is

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    However, a good insight into a patient’s perception of disease and the severity may give a useful vision of pathophysiology and proceeding treatments to physicians [11,12]. The severity of epileptic seizures differs across patients and is a significant factor determining the effect of seizures on patients with epilepsy [13,14]. In this regard, it has been demonstrated that seizure severity is negatively associated with health-related quality of life [13,14].

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