Abstracts

Rationale: A majority of patients with epilepsy achieve seizure control with appropriate treatment; but epilepsy has a profound impact on quality of life(QOL) daily even in the face of seizure control. Determinants of QOL include seizure control, antiepileptic medication (AED) side effects (AEs), ER and hospital admissions, psychiatric co- morbidity, employment, disability and driving status. Referral to a comprehensive epilepsy center should offer opportunity for a coordinated approach to the management of patients with a level of expertise not available in other settings. Methods: A retrospective chart review of patients who have followed at the Minnesota Epilepsy Group for at least one year was performed with IRB approval. Patients must have been seen in clinic within the last 6 months, 100 patient charts were chosen randomly.Data was collected between January and July 2013. Determinants of quality of life were compared at initial visit and at last clinic visit. Patients were between ages 16-65 with regular clinic follow up and documented AED compliance. Developmentally disabled or intellectually disabled individuals or patients with psychogenic nonepileptic seizures were excluded. Results: Patients were referred on average 11.5 years after seizure onset, were 58% female, and had a mean age of seizure onset of 21 years.Patients were followed an average of 6.2 years in clinic. At initial visit: Patients were on a mean of 1.2 AEDs, 32 were on more than one AED and 4 were on no AED. 75% of patients reported having a seizure in the last three months. 47% of patients complained of AEs attributed to AEDs. 18% reported an ER visit related to seizures within the last 12 months. 30% had a diagnosis of depression or anxiety. 79% were reported as employed or studying and 4% were on disability. 25% reported driving. At last visit: Patients were on a mean of 1.6 AEDs with 51% on more than one AED and 2 on no AED. 28% reported a seizure in the last three months. 16% of patients complained of AEs attributed to AEDs. 13% of patients reported a seizure related ER visit in the last 12 months.42% of patients had a diagnosis of depression or anxiety. 66% of patients were employed or studying, while 22% were on disability.76 % of patients reported driving. Conclusions: Referral to a comprehensive epilepsy program resulted in improved seizure control. Patients complained of significantly fewer AEs attributable to Antiepileptic drugs (AED) despite more polypharmacy after referral. This may be due to improved AED selection. ER visits related to seizures were decreased. More patients were found to have depression/anxiety, confirming these as important and common comorbidities. Driving status improved significantly correlating with better seizure control. There was a significant increase in the number on disability. This provided financial and community support which had previously been lacking. Overall patients referred to a comprehensive epilepsy center receive integrated and appropriate care enabling them to achieve an overall improved QOL.