Drug-treatment changes, depression, and quality of life in adults with drug-resistant focal epilepsy.
TL;DR
Seizure freedom can improve all domains of QoL, but mainly Seizure worry, although this can be negatively affected by depressed mood, and improvement in the domain of Social functioning requires a period of sustained seizure freedom longer than 6 months to improve, and it is negatively influenced by persistent depressed mood.
Abstract
Objective
To investigate changes in quality of life (QoL) dimensions and their relationship with seizure outcome, depression, and suicidality after the addition or substitution of an anti-seizure medication (ASM) in adults with drug-resistant focal epilepsy.
Methods
A total of 665 consecutively enrolled patients were followed prospectively and assessed with Quality of Life in Epilepsy Inventory 31 (QOLIE-31) and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). QoL changes over time for the overall population and seizure outcome categories were analyzed with analysis of variance (ANOVA), whereas factors affecting QoL changes were assessed by using a linear regression model.
Results
Seizure freedom was associated with a marked improvement across all QoL domains, ranging from 11 points for Seizure worry to 4 points for Emotional well-being. The presence of depression before starting medication and its persistence during the observation period was associated with a global worsening of QoL across all domains, ranging from 10 points worse for Social functioning, almost 8 points for Energy and fatigue, 6 points for Cognitive functioning, and to nearly 5 points for Seizure worry. The new development of depression during treatment was associated with worsening in specific QoL domains such as Cognitive functioning, Social functioning, and Overall QoL subscales. Persistent positive suicidality screening was associated with progressive worsening in the domain Emotional well-being.
Significance
Seizure freedom can improve all domains of QoL, but mainly Seizure worry, although this can be negatively affected by depressed mood. Improvement in the domain of Social functioning requires a period of sustained seizure freedom longer than 6 months to improve, and it is negatively influenced by persistent depressed mood. In contrast, changes in Emotional well-being are negatively influenced by suicidality. Clinical and demographic variables, including duration of epilepsy and number of comorbidities or concomitant medical problems, showed no correlation with changes in QoL.