Authors :
Presenting Author: Terra Lee, BS, BA – Vanderbilt University, Vanderbilt University Medical Center
Imani Evans, BA – Vanderbilt University, Vanderbilt University Medical Center
Katherine Moreno, BA – Vanderbilt University, Vanderbilt University Medical Center
Bassel Abou-Khalil, MD – Vanderbilt University Medical Center
Shawniqua Williams Roberson, MEng, MD – Vanderbilt University Medical Center
Rationale:
People with epilepsy can experience significant setbacks post seizures, including cognitive decline. Greater seizure severity is associated with worse quality of life (Bautista & Glen, 2009). There is a gap that previous literature implies in understanding cognitive impairments and their effect on patients’ quality of life after seizures (Yerdelen & Altintas, 2016). We examined the relationship between seizure type and reported quality of life among patients evaluated in the epilepsy monitoring unit (EMU).
Methods:
Adult participants with presumed diagnosis of epilepsy were recruited upon EMU admission. We excluded patients with age < 18 years or who could not self-consent. Baseline data collection included demographics, recent (within past week) seizure history, and the Quality of Life in Epilepsy (QOLIE-31) survey. Seizures reported within the week before enrollment were classified based on semiologic descriptions given by the participant or family. Seizures of those who were ultimately diagnosed with nonepileptic events were classified as neither focal nor generalized. The primary outcome measure was the QOLIE total scores (median value 50, range 0-100, higher scores = better quality of life). Secondary outcomes included the cognitive functioning subscale and the overall quality of life subscale. We used the Kruskal-Wallis test to examine differences among seizure types and 3 quality of life measures.
Results:
Of 25, 5 were excluded due to screen failure. Table 1 depicts demographic and clinical characteristics of the remaining 20. Overall QoLIE-31 scores trended lower with generalized seizures (44.9, interquartile range [IQR] 27.2, 51.3) compared to focal (58.4, IQR 40.4, 62.1) but not nonepileptic (40.9, IQR 29.7, 51.9). These differences did not meet statistical significance across groups (p = 0.447 with Kruskal-Wallis test). Cognitive Functioning subscale scores trended lower with generalized (6.2, IQR 3.1, 12.7) compared to focal (10.1, IQR 8.6, 16.5) and nonepileptic (8.1, IQR 5.5, 12.5) with no statistically significant differences (p = 0.320). Overall Quality of Life subscale scores also trended lower with generalized (7.7, IQR 5.6, 8.2) compared to focal (10.2, IQR 8.8, 10.5) and nonepileptic (9.8, IQR 8.6, 10.8) (p = 0.058).
Conclusions:
We saw trends toward worse quality of life among people with generalized seizures. This may be due to consistent loss of consciousness in generalized seizures, therefore increased risk of injury. This study is limited by small sample size and timing of assessment; future work will include a larger cohort with longitudinal (1-week and 1-month) follow-up assessments of seizure frequency, cognition and quality of life. These data will allow us to tailor interventions to improve quality of life among people with epilepsy.
1. Bautista R.E & Glen E.T. Seizure severity is associated with quality of life independent of seizure frequency. Epilepsy Behav. 2009 Oct;16(2):325-9.
2. Yerdelen & Altintas (2016). Health related quality of life in patients diagnosed with epilepsy or psychogenic non-epileptic seizures, Neurosciences, 21(1), 47–51.
Funding:
This study is funded by the GR0106894044030121KAG072030-01 grant from National Institute on Aging.