Abstracts

Rationale: Depression and anxiety symptoms affect approximately 23% and 20% of people with epilepsy (PWE). Previous studies have found that anxiety, depression, or medication side effects may independently impair and serve as predictors of quality of life (QOL) in PWE.

We investigated how anxiety, depression, and adverse side effects of anti-seizure medications (ASMs) influence QOL in epilepsy patients evaluated at the National Institutes of Health (NIH) Clinical Center.

Methods: Validated screening questionnaires, including GAD7 for anxiety, NDDI-E for depression, Liverpool Adverse Event Profile (LAEP) for medication side effects, and QOLIE-31 for QOL were completed by a cohort of 160 patients. Additional clinical data including seizure frequency, disease duration, ASM treatment, psychiatric diagnosis and treatment, and employment status were extracted from medical records. Pearson correlation coefficients were used to assess linear relationships between questionnaire scores. ANCOVA with gender, disease duration, and seizure frequency was used to evaluate the relationships between quantity and type of ASMs, psychiatric diagnoses, and questionnaire scores.

Results: Of 160 patients, 77 (48%) were female, with mean age of 38 (range 12-72), mean seizure onset at age 23 (range 0.02-66), and mean epilepsy duration of 14 (range 0.09-48) years. Anxiety (r=-0.80, p< 0.0001), depression (r=-0.72, p< 0.0001), and medication side effect (r=-0.71, p< 0.0001) scores were negatively correlated with QOL in our cohort. Medication side effect scores were positively correlated with anxiety (r=0.69, p< 0.0001) and depression (r=0.68, p< 0.0001). Anxiety and depression scores were also positively correlated (r=0.76, p< 0.0001). Females reported lower QOL scores (p < 0.05), and experienced increased anxiety (p < 0.001) and depression (p < 0.01) as well as more medication side effects (p < 0.01) compared to males, suggesting a gender difference across these variables. Patients with a formal psychiatric diagnosis of anxiety or depression experienced increased medication side effects (p < 0.01), higher anxiety (p < 0.001) and depression (p < 0.0001) scores, and lower QOL (p < 0.01). Patients pursuing education or employment demonstrated better quality of life (p < 0.01). Across specific ASMs, patients taking lacosamide reported lower cognitive well-being scores (p < 0.05) and those taking topiramate indicated fewer depressive symptoms (p < 0.01).

Conclusions: Our study reinforces the effect of psychiatric symptoms and diagnoses, as well as ASM side effects on QOL in PWE. Female PWE may be more susceptible to anxiety, depression, and medication side effects, with resultant impacts on QOL. Certain ASMs and previous psychiatric diagnoses appear to have differential effects on QOL and ASM side effect profiles which should be taken into account when selecting ASMs. Independent pursuits such as education and career may be beneficial in providing improved locus of control in PWE. These findings have important clinical implications, underscoring the importance of identifying and addressing both psychosocial issues and medication side effects to improve QOL in PWE.

Funding: Please list any funding that was received in support of this abstract.: This work was supported by the NIH Intramural Research Program.