Abstracts

Epilepsy is a chronic illness that negatively impacts quality of life. Cultural factors may have an influence. At Los Angeles County Medical Center, the majority of patients are Spanish-speaking, uninsured, and with low income and level of education. It is important to identify the factors associated with quality of life in this population to provide better care. Two hundred adult Hispanic patients, seen at our epilepsy clinic underwent a structured interview followed by a self-administered questionnaire (English or Spanish). Demographic and other information regarding their epilepsy was collected. The questionnaire consisted of the Quality of Life in Epilepsy-10 (QOLIE- 10) plus 11 additional questions designed to identify more cultural/social concerns. A statistical regression model was used to correlate these factors with mean QOLIE 10 scores. Of the 200 patients interviewed, 61% were female. Mean age was 36 and mean duration of epilepsy was 20 years. 82% spoke Spanish as their primary language. 51% arrived by public transportation. Average number of antiepileptic medication prescribed was 2, and 74% of patients reported compliance. Mean seizure frequency was 1 per month.
Mean percent optimal life scores (QOL) derived from the QOLIE 10 was 69.4%. Seizure frequency was significantly related with QOL, (p [lt] 0.001). QOL decreased by 10% with every increase in category of seizure frequency; one every other month or less, more than every other month up to 2 per month, and 2 or more per month. Epilepsy duration was significantly and inversely associated with QOL (p[lt] 0.04). Patients[apos] gender, age of onset, seizure type, and etiology, did not correlate with QOL.
Language was significantly associated with QOL (p[lt] 0.01). English speaking Hispanics had lower QOL scores compared to Spanish speaking ones. Average length of education was 8 years. Of the 34% of patients who had stopped education due to epilepsy, 46% were below age 30. Patients with higher level of education (high school and above) had significantly lower QOL (p[lt]0.03).
There was a significant association between sense of embarrassment (stigma) and QOL (p[lt] 0.001). Twenty six percent reported being diagnosed with depression or anxiety. Of those diagnosed, 56% were receiving treatment. The question left unanswered the most by patients was regarding driving. Of the 14% of our patients who drove, only 51% owned a driver[apos]s license. Cultural factors and epilepsy burden play a role in quality of life in Hispanic epilepsy patients at a major US urban medical center. Stigma, language, and education had significant relationships with QOL. QOL was also significantly associated with increased seizure frequency and duration of disease. These results are similar to other studies showing refractory epilepsy patients have poor QOL. This information will enlighten health care providers to the needs of this cultural group.