Cognition and health-related quality of life in a well-defined subgroup of patients with partial epilepsy

Abstract

To investigate the extent and nature of the objective and subjective cognitive deficits and health-related quality of life (HRQOL) in adult outpatients with relatively well-controlled partial epilepsy without symptomatic aetiology, who were on carbamazepine (CBZ) monotherapy. Furthermore, we studied the influence of the epilepsy history and medication on various cognitive functions and the HRQOL. 56 outpatients (29 male, 27 female, mean age 41.3 years) with partial epilepsy were compared with 56 age-, gender-, and education-matched healthy controls. Patients were tested on attention, memory, speed of information processing, and executive functioning. Questionnaires aimed at measuring self-perceived cognitive functioning (CFQ) and HRQOL (SF-36) were administered. Mann Whitney-U tests were used to compare the two groups. Linear regression analysis was performed to identify the epilepsy and medication-related factors that are associated with cognitive functioning and HRQOL. Patients scored lower on measures of attention (P = 0.03), learning (P = 0.02) and speed of information processing (P = 0.00). Mental aspects of HRQOL such as fatigue were lower (P = 0.00), whereas physical functioning was unaffected. These patients also expressed reductions in mental functioning as indicated by a low self-perceived cognitive functioning (P = 0.01). Age at onset, duration of epilepsy, seizure type, seizure frequency, localisation, years on CBZ, and CBZ dosage were not related to cognitive functioning or HRQOL. Patients with partial epilepsy, even when able to maintain regular jobs, have impaired cognition and HRQOL that cannot be attributed to their epilepsy history or CBZ dosage or years of CBZ intake. Therefore, physicians should be more aware of their cognition and HRQOL, in addition to the antiepileptic drug regime.

Rates of DSM-IV mood, anxiety disorders, and suicidality in Australian adult epilepsy outpatients: A comparison of well-controlled versus refractory epilepsy

“…These findings are consistent with previous research that failed to find severity of epilepsy predicted PWE who had died as a result of suicide [30,31]. Overall, our results are also consistent with findings that patients with well-controlled epilepsy report similar levels of reduced health-related quality of life as those with refractory conditions [32,33].…”

“…Although the fifth study utilized a diagnostic interview to identify depression, it is now quite dated, and only had a limited sample size of participants (n=88) recruited from general practice [3]. With newer treatment options, Epilepsy & Behavior 26 (2013) [29][30][31][32][33][34][35] therefore, it remains unclear whether this much-cited assumption, that people with refractory epilepsy have higher rates psychopathology in comparison with those whose epilepsy is well-controlled, is supported by sufficient evidence.…”

Psychosocial effects and evaluation of the health-related quality of life in patients suffering from well-controlled epilepsy

“…Moreover, as demonstrated by Ryan et al [9], the HRQOL of epileptic patients is more influenced by the self-perception of stigma than by the history and medication-related variables of the disease. Similar findings as ours, on the impact of epilepsy history variables to the HRQOL outcome, were presented in the Engelberts et al study [3].…”

“…Our results clearly differ from those reported by Jacoby [6] and Aldenkamp et al [1] and are similar to those reported by Engelberts et al [3]. In the latter patients with partial epilepsy even when able to maintain regular jobs, had impaired cognition and HRQOL.…”

Validity of the Neurology Quality-of-Life (Neuro-QoL) measurement system in adult epilepsy

“…Depending on disease severity and seizure frequency, cognitive dysfunction can cause intellectual decline, reduced information processing speed, memory impairments, and attention deficits [58, 59]. Patients with epilepsy can struggle with this dysfunction their entire life because it can affect their education as a child, their social development as they grow older, and their future employment as an adult [49].…”