Abstracts

Rationale: Epilepsy is defined by the occurrence of unprovoked seizures, but seizures have less impact on quality of life (QOL) than the complex profile of comorbidities experienced by persons with epilepsy. Therefore, understanding the interplay between comorbidities and QOL across epilepsy phenotypes is an important step towards improved outcomes. Here, we report the impact of QOL across distinct epilepsy phenotypes in a cohort of post-9/11 veterans with high rates of traumatic brain injury (TBI).

Methods: This observational cohort study used data from the Veterans Health Administration to identify post-9/11 Veterans with epilepsy for survey administration. A process integrating algorithms, chart abstraction, and self-reported measures was used to classify patients into one of four groups: 1. Epilepsy controls, 2. Drug resistant epilepsy (DRE), 3. Post-traumatic epilepsy (PTE), or 4. Drug resistant post-traumatic epilepsy (PT-DRE). Summary scores for six QOL measures were compared across the groups, adjusting for age, sex, and number of comorbidities. Given the collinearity of the 6 QOL measures, an additional analysis was performed on the first two linearly uncorrelated components of QOL.

Results: A total of 529 survey respondents with epilepsy were included in the analysis: 249 controls (i.e., epilepsy without DRE/PTE), 124 with DRE, 86 with PTE, and 70 with PT-DRE. Drug resistant epilepsy was more common in those with PTE compared with non-traumatic epilepsy (45% vs. 33%, odds ratio 1.6 (95% CI: [1.1-2.4], p=0.01)). Patients with PTE and PT-DRE had significantly more comorbid conditions in health records than those with nontraumatic epilepsy. Those with both PTE and DRE reported the lowest QOL across all six measures, and this persisted after adjustment for medical comorbidities, and in further linear analyses.

Conclusions: Among those with PTE, DRE prevalence was significantly higher than for non-traumatic epilepsies. PTE was also associated with higher burden of medical comorbidity, and worse overall QOL compared to those with non-traumatic epilepsies. Patients with PTE are uniquely vulnerable to the comorbidities associated with TBI and epilepsy. This at-risk group should be the focus of future studies aimed at elucidating the factors associated with adverse health outcomes including risk for emergence of DRE.

Funding: Please list any funding that was received in support of this abstract.: This study was funded by the Congressionally Directed Medical Research Program, Epilepsy Research Program, Project W81XWH-16-2-0046. Dr. Gugger reports receiving salary support from the National Institute of Neurological Disorders and Stroke (T32NS091006) and the American Epilepsy Society/Citizens United for Research in Epilepsy (Research and Training Fellowship for Clinicians). Dr. Pugh also received funding from VA Health Services Research and Development Service grant (RCS 17-297). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the U.S. Government, the Department of Defense, or the U.S. Department of Veterans Affairs; no official endorsement should be inferred.