Characteristics associated with quality of life among people with drug-resistant epilepsy

SMILE Team

Research output: Contribution to journalArticlepeer-review

52 Citations (Scopus)

Abstract

Quality of Life (QoL) is the preferred outcome in non-pharmacological trials, but there is little UK population evidence of QoL in epilepsy. In advance of evaluating an epilepsy self-management course we aimed to describe, among UK participants, what clinical and psycho-social characteristics are associated with QoL. We recruited 404 adults attending specialist clinics, with at least two seizures in the prior year and measured their self-reported seizure frequency, co-morbidity, psychological distress, social characteristics, including self-mastery and stigma, and epilepsy-specific QoL (QOLIE-31-P). Mean age was 42 years, 54% were female, and 75% white. Median time since diagnosis was 18 years, and 69% experienced ≥10 seizures in the prior year. Nearly half (46%) reported additional medical or psychiatric conditions, 54% reported current anxiety and 28% reported current depression symptoms at borderline or case level, with 63% reporting felt stigma. While a maximum QOLIE-31-P score is 100, participants’ mean score was 66, with a wide range (25–99). In order of large to small magnitude: depression, low self-mastery, anxiety, felt stigma, a history of medical and psychiatric comorbidity, low self-reported medication adherence, and greater seizure frequency were associated with low QOLIE-31-P scores. Despite specialist care, UK people with epilepsy and persistent seizures experience low QoL. If QoL is the main outcome in epilepsy trials, developing and evaluating ways to reduce psychological and social disadvantage are likely to be of primary importance. Educational courses may not change QoL, but be one component supporting self-management for people with long-term conditions, like epilepsy.

Original languageEnglish
Pages (from-to)1174-1184
Number of pages11
JournalJournal of Neurology
Volume264
Issue number6
DOIs
Publication statusPublished - 1 Jun 2017

Bibliographical note

Funding Information:
Thanks to members of the Trial Steering Committee, Anne Rogers (chair), Howard A. Ring, Phil Smith, Henry Smithson, Ajay Thapar, Marie Edgar, and the Data Monitoring Committee, Gene Feder (chair), Adrian Mander and Mark Manford. This Research was independent and funded by the National Institute for Health Research [Health Technology Assessment, 09/165/01—Self-Management education for adults with poorly controlled epILEpsy (SMILE) A Randomized Controlled Trial]. This report also represents independent research part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. Support for recruitment was obtained from the NIHR Clinical Research Network South London. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Publisher Copyright:
© 2017, The Author(s).

Keywords

  • Anxiety
  • Depression
  • Epilepsy
  • Quality of life
  • Self-mastery
  • Stigma

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