Abstracts

Rationale: Epilepsy is associated with poor psychosocial outcomes and multi-morbidity. The impact of seizures on outcomes has not been evaluated in a national Canadian community based sample. The aim of this study was to examine the impact of epilepsy on persons living with epilepsy stratified by seizure status.Methods: The data source was the Survey of Living with Neurological Conditions in Canada (SLNCC), which accrued its participants from the Canadian Community Health Survey (CCHS), a national population-based survey. The SLNCC included those who reported that they or a member of their household had epilepsy. Participants had to be on a seizure drug or to have had a seizure in the past 5 years to meet the epilepsy case definition. The respondents were further stratified by seizure status: The seizure group experienced ≥1 seizure in the past 5 years vs. the no seizure group who were seizure free in the past ≥5 years regardless of medication status. The SLNCC assessed multiple domains of epilepsy impact (e.g. stigma, informal assistance). For those reporting that they personally had epilepsy, the dataset was enriched by additional CCHS measures. Weighted overall and stratified prevalence estimates with 95% CI (not always reported due to limited space) and odds ratios were used to estimate associations.Results: The SLNCC included 713 persons with epilepsy with a mean age of 45.4 (95% CI 42.4-48.4) years. Fewer of those in the seizure group (42.7%) reported being much better than a year ago vs. those in the no seizure group (70.1%). Medications were the main reason why epilepsy was better in most patients (reported by 86.2 and 97.3% of those with vs. without seizures) while surgery was the reason for improvement in 5.5% of those with and 4% of those without seizures. Of those with seizures, 32.1% (95% CI 18.8-45.3) had depressive symptoms compared to 7.7% (95% CI 3.4-11.9) of those without seizures. Driving, educational and work opportunities were significantly lower in those with seizures (opposite findings for formal and informal assistance and restriction of activity). Stigma was significantly greater in those with seizures (e.g. 20.8% of those with seizures often/always felt embarrassed vs. 8.4% of those without seizures). In the larger CCHS survey, those with epilepsy (n=372) had almost 3 times the odds of suicidality (considered/attempted) vs. those without epilepsy (n=108,739). The odds of other poor outcomes were also greater in those with vs. those without epilepsy (e.g. >2.5 for restriction of activities at home, school, work, etc.).Conclusions: Epilepsy, regardless of seizure status, is associated with poor outcomes. This community-based study however demonstrates the additional impact imposed by ongoing seizures (e.g. a staggering 32% of those with seizures had depressive symptoms compared to 7.7% of those without seizures). These findings highlight the need to refer patients living with epilepsy who have ongoing seizures to epilepsy centers to ensure their care is optimized.