Abstracts

Rationale: Seizure related head injury (SRHI) is an under-recognized condition that is frequently experienced by people with epilepsy (PWE) (Beghi, 2002; Friedman, 2010). The purpose of this study is to investigate the potential impact of SRHI on health related quality of life (HRQOL) among PWE receiving care in a tertiary epilepsy center. Methods: Since February of 2008, the Baylor Comprehensive Epilepsy Center (BCEC) has been systematically assessing for seizure related injury during initial and routine follow-up visits, specifically questioning for a history of injury since their last visit. This has led to a database of over 300 patients, with 74 patients experiencing recurrent injuries, the majority of which (74%) were SRHI (Friedman, 2010). Consecutive adult PWE receiving care at BCEC were recruited for the study. After obtaining informed consent, patients were administered the QOLIE-31, a standardized questionnaire used to measure HRQOL. Because depression had consistently been associated with poor QOL among PWE (Boylan, 2004), the NDDI-E was administered to screen for depression. Clinical variables measured included age, gender, epilepsy classification, epilepsy duration, past and recurrent SRHI, seizure frequency, and seizure type. Injury severity classification was made and based on a previously published scale (Friedman, 2010). The associations between clinical variables and QOL were determined using a generalized linear model with the total QOLIE-31 score representing the dependent variable. Results: A total of 129 patients participated in the study (mean age 38 years, 52% male, median seizure frequency 1/month, median epilepsy duration 15 years). Thirty seven (29%) screened positive for depression, 30 (23%) had a history of remote SRHI with no injury sustained during the two year study period, and 35 (27%) experienced recurrent SRHI during the past two years, with the most recent injury occurring within 5 months prior to completion of the questionnaires (median = 2 months following injury). Most (81%) SRHI were classified as mild and others as moderate. On univariate analysis, age, seizure frequency, depression, past SRHI and recurrent SRHI were all associated with poorer QOL scores on the QOLIE-31. However, on multiple regression analyses, only depression (p <0.001) and recurrent SRHI (p = 0.008) remained as independent predictors. Conclusions: Depression was a strong predictor for HRQOL in PWE and is consistent with other recent observations. These data also demonstrate that recurrent SRHI independently impacts HRQOL. The potential long term clinical effects of SRHI in PWE require further study.