Quality of life in young adults with uncomplicated epilepsy

It's all about quality: Life after pediatric epilepsy surgery

This review addressed health-related quality of life (HRQOL) in children with medically refractory epilepsy and the impact of epilepsy surgery on HRQOL. Risk factors for poor HRQOL include the presence of cognitive, emotional or behavioural comorbidities, parental anxiety and depression, lower family socioeconomic status, stress and demands on the family, epilepsy-related variables and anti-seizure medications. Follow-up studies after epilepsy surgery have identified improvements in HRQOL, although findings are variable with respect to which aspects improved and which child, parent and family factors are associated with improvements. The key and consistent predictor is seizure freedom. Further research utilizing longitudinal designs and longer follow-up durations is needed to identify the timing and trajectories of improvements in HRQOL after surgery.

Health-related quality of life and its predictors among people living with epilepsy at Dessie Referral Hospital, Amhara, Ethiopia: A cross-sectional study

OBJECTIVES

Health-related quality of life of people living with epilepsy is significantly impaired. The disease causes a significant psychological and social impact on daily living conditions and usually has lifelong consequences for the patient and family. Therefore, this study aimed to investigate the health-related quality of life of people living with epilepsy and its predictors in Dessie Referral Hospital, Dessie, Ethiopia.

METHODS

A facility-based cross-sectional study was conducted from April to June 2020. Systematic random sampling was used to recruit a total of 385 study participants. Written informed consent was obtained for each participant, and data were collected using World Health Organization Quality of Life Brief Version and Hospital Anxiety and Depression Scale questionnaires. Descriptive statistics were used to summarize the data, while multivariate logistic regression analyses were used to examine factors affecting the quality of life. P value ⩽ 0.05 was considered statistically significant.

RESULTS

About 95.80% of the study participants had a generalized seizure, and 64.30% were on two antiepileptic drugs. Of the total, 12.20% and 37.00% suffered from depression and anxiety, respectively, based on the Hospital Anxiety and Depression Scale score. The mean total health-related quality of life score was 51.98 (standard deviation: ± 10.08; 95% confidence interval: 41.90-62.06) out of 100. Age, education level, marital status, occupation, residence, current comorbidity, family support, and recreational activities were associated with good health-related quality of life (p ⩽ 0.05).

CONCLUSION

The average overall quality of life of people living with epilepsy in the Dessie Referral Hospital was low. Therefore, concerted efforts must be made to improve the quality of life of patients over the healthcare services provided.

Psychometric evaluation of Persian version of Seizure Severity Questionnaire

BACKGROUND AND PURPOSE

Seizure severity has been increasingly gaining attention as a complementary assessment to seizure frequency for the measurement of treatment responses. This study aimed to assess the reliability and external validity and of the Persian version of the Seizure Severity Questionnaire (SSQ).

METHODS

The study sample was recruited from 126 patients with epilepsy who attended the neurology outpatient clinic at Imam Khomeini and Roozbeh hospitals, Tehran, Iran. The Forward-Backward technique was applied to translate the questionnaire. The reliability of SSQ was assessed by Cronbach's alpha coefficient. The external validity of SSQ was assessed by correlating SSQ scores with Quality of Life in Epilepsy Inventory-31 (QOLIE-31) subscales.

RESULTS

The sample comprised 63 women (50%) and 63 men (50%) aged 13-76 years. The mean scores of SSQ items ranged from 3.46 to 5.48. Distribution was skewed for all component scores, with a tendency for the item scores to concentrate toward the highest scores. Reliability for almost all domains were moderate to good, with Cronbach's alpha ranging from 0.615 to 0.770. Component B to D and total score of SSQ had weak-to-moderate inverse correlation with QOLIE-31 subscale scores. However, the result showed no significant correlation with age, sex, or education.

CONCLUSION

With some limitations, the Persian version of the SSQ shows relatively good reliability and content validity, supporting its use as a specific measure of seizure severity in epilepsy in Iran.

The quality of life among Sudanese patients with epilepsy, Khartoum, Sudan

INTRODUCTION

This is the first study done in the National Center for Neurological Sciences, Khartoum State, to assess the quality of life among more than 100 Sudanese epileptic patients, in the period from September to December 2020.

METHODOLOGY

This is a descriptive cross-sectional study; data were collected using an interview-based semi-structured structured questionnaire and this questionnaire was modified from the SF-36 model.

RESULTS

Most of the patients were from urban areas and origin (60.2%), most of which were housewives; the majority of the patients were single and from low socioeconomic status, history of the disease was less than 3 years for most of the cases covered in this study, most of the cases were classified as generalized tonic clonic epilepsy, and normal EEG findings and normal MRI brain were found in 75.7% and 78.6%, respectively. Most patients mentioned that they experienced no attacks during the last month. Regarding mental health, 47.6% experienced symptoms of depression, and 75.7% had memory problems. In terms of physical health, 51.5% felt energetic all of the time, 9.7% experienced remarkable sleep disturbance, most of the patients are not driving nor have established hobbies during leisure time. 63.1% of the participants do not have health problems; 32% mentioned that they would feel stigmatized if an attack takes place in public. Commonest medication prescribed was carbamazepine, out of which 73.8% are fully compliant with their medication. 95.1% are not worried about long term use of medication.

CONCLUSION

Lower levels of education and manual labor are associated with poor quality of life. Epilepsy has an adverse impact on social life. There is a global decrease in cognitive function, and most of the patients are not worried about the side effects and duration of the medication usage.

Comparison of cognitive function, socioeconomic level, and the health-related quality of life between epileptic patients with attention deficit hyperactivity disorder and without

Background

Epilepsy is one of the most common neurological conditions. Attention deficit hyperactivity disorder (ADHD) in children with epilepsy proves to be very common. Both epilepsy and ADHD impair quality of life. We aimed to evaluate cognitive function, socioeconomic level, and quality of life (QOL) among children with ADHD and epilepsy. A total of 100 children were divided into 5 groups (20 children/group) as (I) epilepsy, (II) ADHD with epilepsy, (III) ADHD with EEG changes, (IV) ADHD without EEG changes, and (V) control. Children aged between 6 and 11 years were recruited for this study. Early Childhood Epilepsy Severity Scale (E-Chess), Conners’ Parent Rating Scale (CPRS), Wechsler Intelligence Scale for Children-3rd edition (WISC-III), socioeconomic scale for assessment of social burden and socioeconomic classes, and PedsQL (quality of life measure) assessed.

Results

Children with ADHD and epilepsy had the lowest PedsQL total scores and lower scores than other groups especially in performance IQ score. The highest percentage of low socioeconomic class (25%) was observed in the group of ADHD with epilepsy and the group of epilepsy.

Conclusion

ADHD with epilepsy is associated with low performance IQ, poor socioeconomic level, and quality of life. Pediatric Quality of Life Inventory scores show significant correlation with total IQ score in the group of ADHD with epilepsy.

Health-related quality of life and associated factors among epileptic patients on treatment follow up at public hospitals of Wollega zones, Ethiopia, 2018

Objective

The aim of this study was to assess health-related quality of life and its associated factors among epileptic patients in public hospitals of Wollega zones, Ethiopia. Institutional based cross-sectional study was conducted on 402 epileptic patients, from March 01 to March 30, 2018. Multiple linear regression with backward elimination was used, and all analyses were conducted at the 0.05 significance level.

Results

The overall mean total score on the WHOQOL-BREF scale was 60.47 with ± 23.07 SD. Monthly income ≤ 500 EB (β = − 12.49, P < 0.001), living alone (β = − 7.11, P = 0.007), adverse drug reaction (β = − 10.86, P < 0.001), comorbidity of anxiety (β = − 12.99, P < 0.001), perceived social stigma (β = − 9.73, P < 0.001) and frequency of seizure once per week (β = − 8.41, P = 0.001) were negatively associated with quality of life of epileptic patients. The mean quality of life of patients living with epilepsy in this study was low. The clinician should early recognize and treat drug side effects, detect and manage comorbidity, and control seizure in order to increase quality of life of epileptic patients.

The "Cinderella Syndrome": A narrative study of social curfews and lifestyle restrictions in juvenile myoclonic epilepsy

Several factors are thought to contribute to inadequate seizure control in patients with juvenile myoclonic epilepsy (JME), including drug resistance, neuropsychiatric comorbidity, and poor lifestyle choices. Recent evidence supports the existence of frontal lobe microstructural deficits and behavioral changes that may contribute to poor seizure control in a minority of patients. Counseling patients on the importance of adequate sleep hygiene and alcohol restriction is an important part of the management strategy for patients with JME. However, information is lacking on how these lifestyle restrictions impact on patients with JME. We conducted a qualitative descriptive analysis of the social impact of JME on 12 patients, from their own perspective. We identified four prominent themes: the importance of alcohol use as a social "norm", how JME affected relationships, decision making (risk versus consequences), and knowledge imparting control. Given that these restrictions were interpreted by patients as social "curfews", we suggest that the term "Cinderella Syndrome" encapsulates the perceived imperative to be home before midnight. Our findings underscore the importance for clinicians to recognize that in counseling patients with JME about lifestyle adjustments, there may be a significant social consequence unique to this patient group.

Quality of life and sense of coherence in young people and adults with uncomplicated epilepsy: A longitudinal study

OBJECTIVES

The aim of the study was, in a ten-year follow-up, to describe and explore potential changes in quality of life and sense of coherence in relation to gender differences among persons with epilepsy in the transition from adolescence to adulthood.

MATERIALS AND METHODS

A longitudinal study of sense of coherence (SOC) and quality of life with repeated measurement design (1999, 2004, and 2009) was conducted in a population of persons (n = 69) who were aged 13-22 years in 1999 and 23-33 years in 2009. The Quality-of-Life Index (QLI) and the Sense of Coherence (SOC) scale were used.

RESULTS

There was a significant decrease (p ≤ 0.001) in seizures compared with the 2004 results, mainly among the women (p = 0.003). When comparing the total QLI scores, no significant differences were found between the three data collections and there were no differences in total scores between men and women. There was a decrease in the SOC total score over the 10-year period study. Total SOC was significantly higher among those being 30-33 years old compared to those being 23-29 years old (p = 0.014) and among those having a driving license (p = 0.029) compared to those not having a driving license.

CONCLUSIONS

Both quality of life and sense of coherence are important for maintaining health and well-being. Promoting health and well-being requires effective high-quality multidisciplinary person-centered care.

Beyond medical diagnosis: Factors contributing to life satisfaction of women with epilepsy in Israel

This study was an exploratory study aimed to examine the contribution of both objective variables (such as education, occupational status, and leisure activity) and subjective variables (such as perceived disability, body image, and feminine self-image) to the life satisfaction of women with epilepsy in Israel. The study also sought to compare the findings with earlier studies of women with epilepsy or other disabilities in order to identify similar patterns in their life satisfaction. The study included 70 women, who had applied in the past to the Israel Epilepsy Association to obtain information and leisure activities. They were asked about their degree of life satisfaction in the context of their personal data including occupational status, leisure activity, perceived disability, body image, and feminine self-image. Findings indicated that higher education and perception of body image and femininity were positively correlated with higher life satisfaction. The regression model showed that perceived severity of disability and body image had the highest contribution to satisfaction with life, a fact that attests to the paramount importance of women's perception of their health disability in dealing with the disorder. These findings are discussed in relation to earlier comparative studies of those with/without epilepsy. The implications for practice suggest aspects that ought to be included in therapeutic interventions such as including contents related to feminine self-image and body image in the rehabilitation process as well as recommendations for future studies.

Life quality and health in adolescents and emerging adults with epilepsy during the years of transition: a scoping review

AIMS

The aims of this study were to (1) search the literature in order to identify the challenges facing adolescents and emerging adults with epilepsy; and (2) categorize these issues within both the framework of the International Classification of Functioning, Disability and Health (ICF) and an empirical model of quality of life (QOL) in childhood epilepsy.

METHOD

We systematically searched PsycINFO, Ovid MEDLINE and Web of Science for studies reporting on QOL and health identified in people with epilepsy aged 12 to 29 years. Studies were limited to those that were published in the last 20 years in English, presenting the patient perspective. Data were extracted and charted using a descriptive analytical method. Identified issues were classified according to the ICF and QOL frameworks.

RESULTS

Fifty four studies were identified. Another 62 studies with potentially useful information were included as an addendum. The studies highlight a range of psychosocial issues emphasizing peer acceptance, social isolation, and feelings of anxiety, fear, and sadness.

INTERPRETATION

The ICF and QOL constructs represent useful starting points in the analytical classification of the potential challenges faced by adolescents with epilepsy. Progress is needed on fully classifying issues not included under these frameworks. We propose to expand these frameworks to include comorbidities, impending medical interventions, and concerns for future education, employment, marriage, dignity, and autonomy.

Seizure frequency and severity: How really important are they for the quality of life of patients with refractory epilepsy

Introduction:

The data in the scientific literature about the significance of seizure severity and frequency for the quality of life (QOL) of patients with refractory epilepsy (RE) are contradictory.

Objective:

Our objective was to assess the impact of the seizure severity and frequency on the QOL of Bulgarian patients with RE.

Materials and Methods:

A total of 70 patients with RE were studied by examining the medical documentation and seizure diaries. All study participants completed quality of life epilepsy inventory (QOLIE-89). Seizure severity of only 59 patients who had a seizure in the last month was assessed by the Liverpool seizure severity scale.

Results:

A limited negative impact of the seizure severity and frequency on some aspects of the physical health, epilepsy, all aspects of the social health and epilepsy and the overall QOL has been demonstrated. A weak to moderate reverse correlation between the specified factors and the respective QOLIE-89 subscales has been found.

Conclusion:

The clinical factors seizure severity and seizure frequency have a limited negative impact mostly on the social aspects of QOL. The study results support the multidisciplinary approach to persons with epilepsy.

[Cohesion and family adaptability in women with epilepsy: cross-sectional study]

Objetivo

Probar la hipótesis de que las mujeres con epilepsia pertenecen a familias con deficiencias en la cohesión y adaptabilidad a la enfermedad, en comparación con mujeres sanas.

Diseño

Estudio transversal analítico.

Emplazamiento

Se incluyó de forma retrospectiva a 263 mujeres de la consulta externa del servicio de neurología y una unidad de medicina familiar del Instituto Mexicano del Seguro Social en Sonora (México), entre 2010 y 2011.

Participantes

Ochenta y dos mujeres epilépticas (casos) y 181 mujeres sanas (grupo control). Muestra apareada por edad y zona de residencia (1:2,2).

Mediciones principales

Se realizó un análisis univariado para variables sociodemográficas, tipología familiar, nivel socioeconómico y nivel de cohesión-adaptabilidad familiar con el cuestionario FACES III. Un análisis con regresión logística se realizó para aquellas variables asociadas a disfunción familiar en mujeres con y sin epilepsia.

Resultados

Se encontró disfunción familiar en el 22% de las mujeres epilépticas (RM = 2,91 [2,17-3,89]; p = 0,0001). El análisis univariado sugirió asociación para presencia de epilepsia, edad, evolución mayor a 15 años con epilepsia, tipología familiar (rural, urbana y tradicional) contra la presencia de disfunción familiar. El modelo de regresión logística confirmó asociación solo para la presencia de epilepsia (RM = 7,30 [4,00-13,33]; p = 0,0001).

Conclusión

El estudio responde la hipótesis de que mujeres con epilepsia viven con familias con mayor deterioro psicosocial, manifestado por deficiencias en la cohesión y adaptabilidad a la enfermedad, en comparación con mujeres sanas.

Long-term seizure outcome following resective surgery for epilepsy: to be or not to be completely cured?

Surgical intervention is expected to improve the quality of life in patients with intractable epilepsy by providing adequate seizure control. Although many previous studies showed various rates of seizure freedom, definite conclusions have not yet been made regarding outcomes. In order to clarify the long-term postoperative outcome for a period up to 10 years, a retrospective review of our patients was performed longitudinally by using the survival analysis method. The postoperative state of epilepsy in 76 patients who underwent resection surgery was assessed based on Engel’s criteria. In addition, Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom. In this patient group, abnormal lesion were detected by MRI in 70 out of 76 cases, and the ictal onset zone was finally identified within temporal lobe in 51 cases. The most favorable outcome, defined as Engel Class Ia, was observed in 26 (37%), 24 (40%), and 18 (41%) cases at 2, 5, and 10 years after surgery, respectively. The Kaplan-Meier survival curve in the overall group estimated the probability of seizure freedom as 75% (95% confidence interval [CI] 70–80%), 67% (62–72%), and 51% (45–57%) at 2, 5, and 10 years follow up, respectively. Half of all seizure recurrences occurred within the first 2 postoperative years. In this study, we showed that long-term favorable outcome of seizure control following resection surgery can be achieved in more than half of the patients.

Patients' perceptions of living with epilepsy: a phenomenographic study

AIM

The study aimed to describe how patients with epilepsy perceive living with epilepsy.

BACKGROUND

Epilepsy signifies a medical diagnosis as well as a social label. Persons living with epilepsy have more psychosocial problems compared with the general population, and stigma is often experienced. Few studies address patients' life situations as a whole, and there are no studies on how patients perceive living with epilepsy.

DESIGN

This was a qualitative interview study where 19 outpatients were purposively chosen and interviewed.

METHOD

A phenomenographic approach was used for interviewing and for analysing the interviews.

RESULTS

Living with epilepsy was perceived in two different ways depending on the person's feelings towards the condition. A positive feeling signified 'Living with epilepsy means living a normal life - gaining and maintaining control' with the descriptive categories: 'Accepting the person with epilepsy', 'Taking responsibility' and 'Appreciating the good things'. A negative feeling signified 'Living with epilepsy means living with focus on the condition - conflict and avoidance or resigning to fate' with the descriptive categories: 'Struggling with feelings of stigma, prejudices and loss of control' and 'Giving up hope of recovery, accepting loss of control'.

CONCLUSION

The findings indicate that patients' perceptions of living with epilepsy are closely related to their feelings towards the condition. There is a need for further exploration of the relationship between perceptions of epilepsy as a phenomenon, perceptions of living with epilepsy and feelings related to the condition. Relevance to clinical practice.  The findings demonstrated how important feelings and perceptions are to how patients with epilepsy regard themselves. This knowledge is essential for nurses when helping patients to better understand underlying reasons for their reactions to various situations. Forming interventions to help patients with epilepsy to find coping strategies that enhance self-esteem and self-value is another area of relevance.

Coping style and quality of life in patients with epilepsy: a cross-sectional study

Having epilepsy has a large impact on one's well-being, but often seizure frequency and severity do not explain self-reported quality of life. We hypothesized that one's personal coping style is more important. In this study, 105 patients attending the outpatient neurological clinic at the University Medical Centre in Utrecht, the Netherlands, with a diagnosis of partial epilepsy, aged 17-80 years, completed questionnaires. Demographic information, disease characteristics, health-related quality of life (HRQoL), and coping styles were obtained by postal-validated HRQoL questionnaires: the EQ5D and RAND-36 and the Utrecht Coping List. A passive coping style explained 45% of the variance in the mental component of HRQoL and was more important than 'objective' seizure-related measures. Confounders such as employment, gender, and side-effects of treatment explained another 6%. Passive coping style also influenced the physical component of the HRQoL, but here seizure-related factors predominated. Overall, epilepsy patients showed a more avoiding coping style, and female patients a less active coping style and more reassuring thoughts, compared to the Dutch population. The personal coping style of patients appears to be more important than seizure-related measures in predicting mental aspects of quality of life. Coping style characteristics rather than disease characteristics should guide clinical decision-making in patients with epilepsy. Further studies should investigate the effect on HRQoL of behavioral interventions to improve coping.

The contribution of seizures to psychosocial ill-health

Persons with a chronic health condition may be disadvantaged compared to others, though the precise pattern of disadvantage will vary from one condition to another. Persons with epilepsy have been shown to be at increased risk of both psychological morbidity and social disadvantage. Various clinical characteristics of epilepsy have been linked to these psychosocial risks, primary among which is seizure frequency: studies linking seizure frequency to psychosocial ill-health are reviewed here. Given the apparently powerful influence of seizure frequency, it is unsurprising that psychosocial health trajectories in epilepsy are very closely linked to its clinical course-but the relationship is not a completely linear one. Recent research has begun to unravel factors other than seizure frequency which appear promoting or protective of psychosocial ill-health. The need for a more nuanced approach to understanding the causes of psychosocial ill-health is highlighted, as is an important distinction between epilepsy as biomedically defined disease and as socially defined illness.

Quality-of-life trajectories in epilepsy: a review of the literature

The potential psychosocial sequelae of epilepsy are well-documented, but it cannot be assumed that trajectories for quality of life (QOL) of people with epilepsy will inevitably follow its clinical course. In this article, we draw on available literature to suggest likely QOL trajectories associated with epilepsy and the broad range of disease-, patient-, and other-focused factors that appear important in determining them. We conclude that both the likely shape and time frame for QOL trajectories associated with particular clinical scenarios can be delineated, but that their shape can be altered by a much wider range of factors than those represented as epilepsy disease progression. We identify contributory factors currently relatively unexplored and highlight implications for treatment and areas for future research.

Daily life in epilepsy: patients' experiences described by emotions

OBJECTIVE

According to the literature, emotions are closely related to health and well-being. The aim of this study was to illuminate the impact of epilepsy on daily life in young adulthood, described by the patients' emotions.

METHOD

Young adults, 18-27 years of age (n=95/102), answered a questionnaire eliciting descriptions of their daily lives with epilepsy in their own words. A content analysis was performed, and the material was categorized, according to the Belief Desire Theory of Emotions.

RESULTS

The patients experienced positive (confidence, hope, harmony, and forbearance); negative (anxiety, despair, fear, resignation, indignation, sadness, insecurity, and anger); and self-evaluating emotions (being valuable, being insignificant, shame, guilt, and self-doubt). Two different groups of patients could be identified: one group whose members regarded themselves as "healthy" and another group whose members regarded themselves as being ill or "handicapped". The "healthy" group was active and flexible, focusing on possibilities and planning how to handle negative emotions. The "handicapped" group was passive and resigned to the epilepsy in a negative way, afraid of being exposed. They focused on obstacles, and their negative emotions were also directed toward the self.

CONCLUSION

This study pointed out the importance of paying attention to the role of emotions in the experiences and well-being of patients with epilepsy.