Abstracts

Rationale: The impact of epilepsy on everyday life cannot be solely attributed to seizure frequency. Studies of psychosocial effects of epilepsy highlight the prevalence of anxiety and sleep disorder in people with epilepsy (PWE), even though their relationship with epilepsy is not fully understood. There is a need to raise awareness of these problems so that due consideration can be given to them when prescribing and evaluating treatment regimes. Methods: Questionnaires were mailed to two UK samples: a tertiary clinic population (n = 550) and members of the patient organisation, Epilepsy Action (EA; n = 1000). Additionally, EA members could complete questionnaires on-line. Questionnaires were also distributed to an opportunity sample of controls without epilepsy. Questionnaires contained previously validated scales to assess levels of anxiety, day/night-time sleep disorders, adverse drug effects, sense of stigma, levels of social support and key clinical and socio-demographic features. Questionnaires were returned by 196 clinic patients, 751 EA members and 297 controls. Data were analysed using correlation and regression analyses. We used the Speilberger State-Trait Anxiety Inventory (40 items, 20 state, 20 trait) to assess intensity of symptoms; the Pittsburgh Sleep Quality Index (PSQI; 19 items, subjects with global score >5 classified as poor sleepers) to assess night-time sleep quality; and the Epworth Sleepiness Scale (8 items, subjects classified normal or needing special advice ) for daytime sleepiness. Results: The epilepsy samples differed in their clinical status, with the clinic sample significantly more likely to have experienced multiple seizures in the previous year (p<0.001), a higher average number of seizures per month (p<0.001), earlier age of seizure onset (p=0.024), polytherapy (p<0.001) and other long-term co-morbidities (p<0.001). Prevalence of both state and trait anxiety was similar for both samples and significantly higher than for controls (p<0.001 for both). Prevalence of daytime sleep problems was 40.9% in the clinic sample, 38.1% in the patient organisation sample, and 23.7% in the control group (p<0.001); and of night-time problems was 67.1%, 79% and 62% respectively (p<0.001). Factors predictive of state anxiety were: general health, health compared to 1 year ago, seizure worry, level of social support, night-time sleep quality and age. For trait anxiety, important factors were: general health, age at first seizure, seizure worry, day and night-time sleep problems, social support, age and gender. PSQI scores were predicted by other long-term co-morbidities, other (non-AED) medications, adverse drug events and state but not trait anxiety. Conclusions: Management of PWE requires a holistic approach addressing these wider patient-reported problems, as well as epilepsy-specific ones. Study findings will be disseminated to healthcare professionals, for consideration when establishing treatment regimes and management policy. Study funded through an Investigator Initiated Research Grant from Pfizer Ltd and sponsored by University of Liverpool.