Abstracts

Rationale: The impact of epilepsy on patient quality of life has been well described; however there have been few longitudinal investigations into patient quality of life (QOL) during diagnosis and treatment. The 2014 American Academy of Neurology Epilepsy Update Quality Measurement Set identified improvements in diagnosis, education, and referrals and access to treatment as key components in the overall well being of epileptic patients. So too may other aspects of a patient’s psychological and social well being play a role in both patient treatment and the successful management. To date, no studies have evaluated the impact of a psychosocial assessment on all patients admitted to an EMU regardless of pathology irrespective of the diagnosis of epilepsy or psychogenic nonepileptic seizures (PNES).Methods: We performed a retrospective review of 52 patients hospitalized within an academic, Level 4 epilepsy monitoring unit (EMU) from January-June 2015. Subjects included 27 patients with confirmed epileptic seizures, 10 with no events while monitored, 8 with confirmed PNES, 6 with unclear event etiology, and 1 patient with both epileptic seizures and PNES. Patients were assessed for psychosocial considerations via the QOLIE-10, PHQ-9 depression, and GAD-7 generalized anxiety screening tools. Patients were assessed via interview for adjustment to diagnosis, orientation and education level, medication compliance, social situation, barriers to transportation, access to social services, abuse history, and financial support or limitations. Patients with identified depression, anxiety, or social limitations were provided with lists of resources for mental health and social services. As part of our ongoing analysis, patients will be reassessed in 6 months following their initial hospital stay for changes in their psychosocial circumstances as well as change in their management or response to therapy.Results: Nearly half of all patients assessed reported anxiety and depression ranging from moderate to severe with only 30% receiving mental health services at time of assessment with a higher percentage of patients with PNES receiving mental health care at the time of their admission to the EMU. Evaluation of patient utilization of mental health and social services as well as change in patient self reported anxiety, depression, or psychosocial constraints are ongoing to allow for a 6 month follow up comparison.Conclusions: Caregivers should give specific attention to providing patients monitored in the EMU setting with resources for social well-being and mental health. These factors build upon what is known about the complicated interplay of the lifestyle of the epileptic patient and their ability to successfully navigate and respond to treatment. Given the prevalence of comorbidities such as anxiety and depression in EMU patients, we expect that providing the patient with access to such resources will be of benefit to the patient’s overall QOL. We are currently expanding on our case review by completing follow-up assessments of changes in patient quality of life in response to awareness of psychosocial services.