Authors :
Presenting Author: Mary Jo Pugh, PhD, RN – Salt Lake City VA and University of Utah
Eamonn Kennedy, PhD – University of Utah
Samin Panahi, PhD – VA Salt Lake City Health Care System
Sidney Hinds, MD – 7SCS Consulting, LLC, Winsted, Connecticut, United States of America
Rationale: Recent studies suggest the existence of distinct phenotypes of comorbidity among people with epilepsy that convey varying risks for adverse outcomes including mortality. However, prior work has not examined how quality of life and functional measures may be differentially associated with distinct epilepsy comorbidity phenotypes.
Methods: We identified Veterans with epilepsy using from Department of Defense & Veterans Health Administration health system data (2002-2018). We previously reported latent class analysis that identified six Epilepsy Comorbidity Phenotypes (ECP) describing health trajectories over time (1. Relatively
Healthy, 2. PTSD, 3. Polytrauma (TBI, mental health, pain), 4. Bipolar Disorder/Substance Use Disorder (SUD), 5. Chronic Disease, and 6. Anxiety/Depression
). We then identified and surveyed a random sample of 2400 individuals (~400 individuals from each of the six ECPs), oversampling women (~50% vs. 18% of the cohort). The online survey examined quality of life and resilience using a range of instruments, including the Veterans RAND-12, the Quality of Life in Brain Injury (QoLIBRI), Quality of Life in Epilepsy (QoLIE-10), two of three Personal Impact of Epilepsy (PIES) scales (seizure severity and medication effects), and the Response to Stressful Life Experience (RSES) measure of resilience. We used analysis of variance to identify differences among the ECP.
Results: Among the 482 individuals who responded to the survey, comparing ECPs revealed statistically significant differences across all quality of life measures except for the PIES seizure severity scale. Veterans in the Relatively Healthy ECPs had the best scores across all measures. Polytrauma and PTSD ECPs had significantly worse symptom reports with significantly higher scores on the PIES medication effects and QOLIE-10 (
p=.01; high=worse), and significantly lower scores on the QoLIBRI and the VR-12 physical and mental component scales, as well as the RSES (
p< .01 low=worse).
Conclusions: This study identified significant differences in quality of life among ECP. Findings from this study revealed two ECP characterized by higher probabilities of TBI (PTSD and Polytrauma) that scored less favorably on all but one measure tested. This adds to prior mortality findings which found that Bipolar/SUD and Chronic Disease ECPs have higher hazards for all-cause mortality; Bipolar/SUD and Polytrauma ECPs had the highest hazard for death by suicide and death by accident; and Bipolar/SUD and Chronic Disease ECPs had the highest hazard for death by chronic disease. Taken cumulatively, these findings suggest ECPs display different health impacts—some in the short term (e.g., quality of life) and some longer term—mortality. These findings suggest that public health approaches (e.g., healthy lifestyle, stress management) beyond epilepsy specific patient education (e.g., driving) may be important for improving health status and quality of life in people with epilepsy.
Funding:
This study was funded by the Congressionally Directed Medical Research Program-Epilepsy Research Program Award W81XWH-18-1-0247 and VA Health Systems Research-Research Career Scientist award (1IK6HX003762; Dr. Pugh).