Abstracts

Rationale: The Personal Impact of Epilepsy Scale (PIES) was developed to define how epilepsy influences multiple components of life for people with epilepsy in  three domains: seizure severity, medication side effects, and comorbidities.  Previous studies have looked at the impact of epilepsy using single-focus assessments lacking at least one of the domains addressed by the PIES.  This is the first study to describe the impact of epilepsy on veterans with epilepsy (VWE) using the PIES, as well as convergent/divergent validity assessed by sensitivity of PIES to differences among theoretically meaningful groups and correlations with theoretically meaningful measures. Methods: A postal questionnaire was used to examine patients reported outcomes among a national sample of 1,500 VWE who were treated at the Veterans Health Administration for >2years between 2012-2014. Survey items included the PIES, QOLIE-10, Confidence in Epilepsy Self-Care (CESC) and demographic characteristics. Data from the survey was then aggregated with VA medical records for analyses. Results: Surveys were returned by 535 male and female VWE (36% response rate).Patients aged 65 and older had higher scores on all PIES subscales compared to patients aged 45-64 and under 45. Men had higher Subscale A and Subscale B scores compared to women. Patients with more seizures in the past 3 months had lower Subscale A scores and those who had previously received more epilepsy medications had lower Subscale B scores. Patients with diagnosed psychiatric comorbidities had lower Subscale C scores. Total PIES scores positively correlated with the QOLIE-10 score(r=0.74 (0.69, 0.78)) and were not correlated with the CESC score (r=0.01 (-0.13, 0.16)). Conclusions: The PIES is a sensitive measure of seizures severity, medication side effects, and comorbidities as indicated by relationships between scale scores and seizure frequency in the past 3 months, the number of epilepsy medications ever taken, and diagnosed psychiatric comorbidities in VWE. The PIES is also highly correlated with the QOLIE-10. Our study further validates the use of PIES in assessing overall quality of life for PWE.Lack of correlation between PIES scores and CESC scores suggest that the impact of epilepsy on patients is independent of patient self-management and self-education. This implies that patient’s confidence in managing epilepsy may not be reflected in the impact of epilepsy as those with severe epilepsy may be confident in their ability for self-care and have good self-management. This illustrates the importance of medical management of epilepsy and comorbidities.Older patients having higher PIES scores compared to younger patients is consistent with previous research which showed older patients may be able to better cope with certain aspects of epilepsy. The differences in PIES scores seen in male patients and female patients may reflect the differences in epilepsy etiology, prognosis, treatment and social impact between gender.These analyses support the convergent and divergent validity of the PIES. Further research is needed to define minimal clinically important differences in PIES scores. Funding: VA Health Services Research and Development Service IIR 11-067