Abstracts

Rationale: Polypharmacy sometimes is necessary for control of otherwise medically intractable epilepsy. Unfortunately, polypharmacy sometimes results in increased adverse effects (AE) or neurotoxicity (effecting mood, attention, or sleepiness), possibly adversely affecting quality of life (QOL). The purpose of this study was to determine the association of polypharmacy or particular anticonvulsant with QOL and other comorbidities controlling for seizure control status. Methods: Consecutive patients with epilepsy presenting to the comprehensive epilepsy care clinic were surveyed. Patients with psychogenic non-epileptic spells and those not on any anti-epileptic drug (AED) treatment were excluded. All subjects were surveyed on quality of life (QOLIE-P-10) and seizure status (seizure free or not within the prior 4 weeks). Information regarding the number and type of AEDs used was collected. Further variables investigated via questionnaire included insomnia (ISI), sleepiness (ESS), mood (Center for Epidemiological Studies Depression Scale CES-D), and sleep-wake timing (Horne-Ostberg Morning-Eveningness Questionnaire MEQ). The relationship of these factors with polypharmacy was evaluated with univariate comparisons. Significant variables were then evaluated against polypharmacy status via binomial regression. Results: 207 patients completed questionnaires. 119 (57%) of patients were on monotherapy, and 88 (43%) were on 2 or more AEDs. Patients on polypharmacy were more likely to have continuing seizures (49 (56% versus 37 (31%), Fisher's exact test 0.001), had more evening-weighted sleep-wake patterns (mean QEQ score 52.1 9.6 versus 55.6 11.1 t-test p-value 0.017) and had worse quality of life scores (mean 33.3 6.9 versus 36.7 5.7, t-test p-value 0.005). Polypharmacy was associated with worse quality of life (Odds ratio 11.46 and 95th CI 2.06-63.88) even after controlling for seizure status. Additions of chronotype or depression offered no improvements to the binomial model. Of the 5 most commonly used AEDs (LEV, LMT,ZON, LAC, CBZ), none had statistically significant independent association with QOL except LAC (P=0.002), but no patients were on LAC monotherapy. Conclusions: Polypharmacy is associated with worse QOL in epilepsy patients, irrespective of seizure control. This was not attributable to co-morbid depression, insomnia, or daytime sleepiness. QOL is an often overlooked parameter in care of epilepsy patients, but has significant implications for their overall health and well-being. Further investigation into specific etiology of polypharmacy's influence on QOL is warranted, in order to develop paradigms for optimal treatment. Funding: none