Abstracts

Rationale: Despite evidence that quality of life in epilepsy patients is multifactorial, many healthcare providers continue to view effective seizure control as the single main determinant of successful treatment. In this study, we aim to: 1- characterize the quality of life in a cohort of outpatients with epilepsy, and 2- evaluate the factors influencing it. Methods: Since November 2008, the Cleveland Clinic Epilepsy Center has incorporated the collection of patient-entered validated measures of overall health into routine clinical practice. These include assessments of quality of life (Quality of Life in Epilepsy questionnaire, QOLIE-10), seizure severity (Liverpool Seizure Severity Scale, LSSS), and a screening tool for depressive symptoms (Patient-Health-Questionnaire, PHQ-9) among others. Patients enter their answers in the office waiting room via dedicated electronic tablets prior to every visit. Their responses are reviewed by the treating physician during the outpatient appointment. The physician then answers a set of provider-specific questions pertaining to diagnosis and treatment, approving the incorporation of both physician and patient-entered questionnaires into the patient s electronic medical record and a central electronic database. In this study, we analyze data collected on adult epilepsy patients from 11/08 to 03/10. QOLIE-10 scores are the primary outcome measure. After univariate analyses (t-test and chi-square tests), a multivariate linear regression analysis is performed. Each patient is included only once. Results: 2185 patients with a confirmed clinical diagnosis of epilepsy, as established by a neurologist with subspecialty training in epilepsy and neurophysiology, were included in this analysis. The questionnaire completion rate was 79%. Mean age was 43.8 years (range 19-98 years median= 42, s.d. 15.7). Fifty four percent were female. The mean QOLIE-10 score in the overall cohort was 21.3 (95% C.I. 20.9-21.6, s.d. of 8.6, range 10-50). Clinical and demographic patient characteristics, and results of the univariate analysis of the QOLIE-10 score predictors are shown in Table 1. After multivariate regression, factors that retain statistical significance include: driving, work status, seizure severity, number of antiepileptic medications, marital status, and depression (R square=0.59, p<0.0001). Of all these variables, the two with the most clinically significant implications (a QOLIE-score difference>1-1.5 s.d) were seizure severity (mean QOLIE-10 score 28.5 if LSSS>40 opposed to 18.8 otherwise; effect size 1.8) and depression (mean QOLIE-10 score of 30.7 if PHQ-9 ?10 as opposed to 18.5 otherwise, effect size 3.4). Specifically, although depression and seizure severity were related (51% of patients with severe seizures were depressed as opposed to 17% otherwise; p<0.0001), depression remained a major determinant of the quality of life regardless of seizure severity (Fig 1). Conclusions: Improving the quality of life in patients with epilepsy requires attention to a multitude of factors beyond seizure control, particularly depression, to optimize treatment outcomes.