Abstracts

Rationale: The incidence of epilepsy has been steadily increasing in the geriatric population over the past two decades. Despite recognition of the magnitude of this problem, little is known regarding the impact of seizures on bio-psycho-social aspects of quality of life (QOL) and self-perceptions of health status in the elderly with incident epilepsy after the age of 65. This study represents the first attempt we are aware of, that directly addresses the impact of incident epilepsy on perceived QOL in the geriatric population.Methods: We analyzed data from a longitudinally-followed, community-based cohort (n=878), enrolled initially as cognitively normal, without neurologic comorbidity, including current or past seizures, over the age of 65. The incidence of seizures in our population was 300 per 100,000 person years. The SF-36 questionnaire, a multi-purpose, short-form, health survey with 36 questions that yields an 8-scale profile of perceived functional health and well-being was used to determine the perceptions of QOL in subjects that remained cognitively normal, including those with or without seizures reported in the longitudinal follow up period (n=611; 267 subjects developed cognitive decline during longitudinal follow up confounding SF-36 data, were appropriately excluded from the analysis). Standard descriptive and comparative statistics were used to analyze the data.Results: Average follow up for subjects was 7 years (range: 1-25 years). Among the 611 subjects who remained cognitively normal across all longitudinal visits, 12 reported a history of new onset seizures. Ten of these twelve subjects were seizure free as a result of treatment, with only 2 experiencing recent seizures. No between-group differences were found for demographic variables including age, education, gender, or minority status. In contrast, statistically significant differences were found in 9 items on SF-36, involving perception of increased physical disability (p<0.01; t-test), frailty (p<0.04; t-test), emotional health limitations (p<0.03; t-test), anxiety and sadness (p<0.04; t-test), problems interfering with social activities (p<0.0001; t-test).Conclusions: The present results demonstrate that incident epilepsy has a profound impact on perceptions of bio-psycho-social functions and QOL in the elderly population. While several small cross-sectional studies of prevalent epilepsy in the elderly have suggested lower QOL in such subjects, our study is the first to examine the impact on perceived health status and QOL in the elderly with new onset seizures. Health care professionals, while being mindful of other confounds affecting QOL in this population, should address the potential impact of seizures with their geriatric patients and provide education and psychosocial support to confront this important issue as part of comprehensive epilepsy care. Future work aimed at validating our results and increasing our understanding of this phenomenon is important in guiding the development of interventions designed to improve perceptions of health status and QOL is needed.