Abstracts

To determine factors that contribute to health-related quality of life (HRQOL) in patients with epilepsy. The goals of successful antiepileptic drug (AED) therapy are seizure freedom, lack of side effects and normal quality of life. Recent studies indicate that a change to an AED with a lower adverse event burden may improve quality of life in patients with epilepsy without sacrificing seizure control (Gilliam Neurology 2002 58:S9-S20). Data for this analysis were collected at time of enrollment as part of a large outpatient epilepsy study. Patients with epilepsy age 16 years and older enrolled due to poor seizure control or unacceptable side effects on their current AED therapy. We measured the Quality of Life in Epilepsy-31 (QOLIE-31), Profile of Mood States (POMS), and Adverse Events Profile (AEP). The QOLIE-31 is a 31-item assessment of overall quality of life with higher scores indicating better quality of life scores; scores range from 0-100. The POMS is a 65-item assessment of overall mood with higher scores indicating greater mood disturbance; total mood disturbance scores range from 32 to 200. The AEP is a 19-item assessment of AED adverse event burden with higher scores indicating greater burden; scores range from 19-76.
The primary outcome measure for this analysis was QOLIE-31 overall score. Variables analyzed included: age, gender, ethnic origin, seizure duration, seizure etiology, seizure type, reason for entry into study, average monthly seizure frequency, POMS subscales (depression/dejection, tension/anxiety, fatigue/inertia, confusion/bewilderment, anger/hostility, and vigor/activity) and the AEP score. Stepwise linear regression was performed to determine which factors independently correlate with overall QOL. 196 patients enrolled (mean age 43 years, 58% female, median baseline seizure frequency 2/month). The majority of patients were taking older AEDs, including carbamazepine, phenytoin, and valproate. Multiple Linear Regression revealed that AEP score (P=[lt]0.0001), total POMS score (P=[lt]0.0001), anger/hostility subscale (P=0.0002) and confusion/bewilderment subscale (P=[lt]0.0001) were independent predictors of the overall QOL. Seizure frequency was not an independent predictor of overall QOL. These preliminary results suggest that medication side effects and overall mood state are the most important determinants of the variability in HRQOL in patients with epilepsy in a community neurology setting. (Supported by GSK Research and Development)