Cross-cultural differences in health-related quality of life of people with epilepsy: findings from a European study

Knowledge of epilepsy in the general population based on two French cities: implications for stigma

The objective of this study was to assess the knowledge and attitudes of people living in two French counties. The data were collected from 1777 adults in the general population who were interviewed. Knowledge of and attitudes toward epilepsy in these French samples proved largely favorable: 90.6% identified epilepsy as different from a mental disorder or lunacy, and 79.2% correctly identified epilepsy as a brain disorder. The majority agreed with the statements that people with epilepsy should have the opportunity to get married and that children with epilepsy should be allowed to go to school with others. However, gaps in knowledge and erroneous beliefs prevailed, notably among men, old people, and individuals with low levels of education. This study yielded encouraging results. However, further studies are needed to confirm these findings and gain a better understanding of the contribution of French public knowledge to the causative factors generating stigma in France.

Multiple impacts of epilepsy and contributing factors: findings from an ethnographic study in Vietnam

We investigated issues related to treatment, impact of epilepsy, attitudes toward epilepsy, and disclosure in Vietnam through in-depth interviews with people with epilepsy (PWE) and their family members. We found that although participants prefer Western to traditional treatment, they experience problems in accessing different kinds of antiepileptic drugs and higher-level treatment facilities and with respect to treatment expenses. The impact of epilepsy can be observed in a wide range of daily living activities which include working, education, marriage, and family formation. Although both families and society at large do not hold negative attitudes toward epilepsy, most PWE reported a sense of burden to others. Both PWE and family members generally prefer disclosing epilepsy rather than concealing it from others. Our findings strongly suggest a need in Vietnam for different types of antiepileptic drugs and epilepsy support information for PWE, family members, and the general public.

Health-related quality of life of patients with epilepsy in Turkey

The aim of this study was to measure the health related quality of life (HRQOL) of epilepsy patients and to compare it with that of a healthy control group. The evaluation included the effects of the type of seizure, duration of seizure and medical treatment on the quality of life of the patients. The group studied consisted of 221 participants (121 epilepsy patients and 100 healthy control individuals) who completed a sociodemographic data form and who were administered the World Health Organization Quality of Life (WHOQOL-100) scale. The epilepsy patients had statistically lower physical health, psychological well-being, level of independence and global HRQOL than participants in the control group (p<0.05). The analysis of variance showed that the partial epilepsy subgroup had significantly lower averages for all the quality-of-life subfields except for the social relationship dimension. On regression analysis, being married, having a generalized type of seizure and being treated with fewer medications were all related to higher scores on the HRQOL. Epilepsy is a disease that has neurological, psychiatric and psychosocial dimensions that should be evaluated using a multidisciplinary approach.

Health-related quality of life in Austrian elementary school children

BACKGROUND

Health-related quality of life (HRQL) is frequently used as an outcome criterion to evaluate the quality and effect of different therapies. However, little is known about the HRQL of the general population, the prevalence of specific HRQL problems and about which factors have an impact on HRQL assessments.

OBJECTIVE

To examine children's HRQL from their own and their parents' perspectives. The study sample consisted of children attending the third and fourth grades of elementary school in the capital of Austria, Europe.

METHODS

One thousand four hundred twelve children and 1185 parents completed child- and parent-versions of the Pediatric Quality of Life Inventorytrade mark (PedsQLtrade mark). In addition to the PedsQL questions, children and parents were asked a number of questions with regard to sociodemographic information and specific problems that were hypothesized to be associated with the children's HRQL.

RESULTS

Altogether, the children demonstrated a good HRQL and their PedsQL scores were similar to those of children from other developed countries. About 15% of children showed a notably low HRQL, and two-thirds of these children were from financially less privileged families. Multivariate regression analyses identified the following factors associated with the children's HRQL: the family's perceived financial situation, parents' quality of life, children's school performance, medical and/or psychologic problems (eg, dyslexia, recurrent stomachache or headaches), chronic disease, a recent life-event (eg, divorce/separation of parents), and parents' satisfaction with school.

CONCLUSIONS

Assessing children's HRQL may be helpful to take preventive action and to identify those who are in urgent need of special services.

Prevalence of convulsive epilepsy and health-related quality of life of the population with convulsive epilepsy in rural areas of Tibet Autonomous Region in China: an initial survey

OBJECTIVE

The purpose of this study was to establish the prevalence rate of convulsive epilepsy and the treatment gap in some rural areas of Tibet Autonomous Region in China, to evaluate the quality of life (QOL) of patients with epilepsy and identify factors contributing to their QOL.

METHODS

A door-to-door epidemiological survey using randomized cluster sampling was conducted in a rural population in Tibet. A screening questionnaire for convulsive epilepsy was used. Clinical and sociodemographic data were collected from patients confirmed as having convulsive epilepsy. QOL was measured with the Quality of Life in Epilepsy inventory (QOLIE-31). Factors associated with QOLIE-31 total and subcomponent scores were analyzed by multiple regression analysis.

RESULTS

A total of 14,822 people were screened. Of these, 37 were confirmed to have convulsive epilepsy, which was active in 35. Lifetime prevalence was estimated to be 2.5 per 1000 in this population. Nearly 60% of patients received traditional Tibetan treatment; 97% of the patients with active epilepsy did not receive reasonable antiepileptic therapy in the week before the survey (treatment gap). The mean QOLIE-31 total score was 42.2 (SD 17.6), with the lowest subcomponent score 22.6 (SD 20.3) for Seizure Worry and the highest 85.8 (SD 18.6) for Medication Effects. High seizure frequency, low economic status, advanced age, late seizure onset, and high education level significantly correlated with low QOLIE-31 total and/or subcomponent scores.

CONCLUSIONS

The prevalence rate for epilepsy was relatively lower than reported for other rural regions; however, the large treatment gap and poor QOL indicated the pressing needs for medical, financial, and social support in this population.

Marked benefits in physical activity and well-being, but not in functioning domains, 2 years after successful epilepsy surgery in children

In this first study comparing epilepsy-specific quality-of-life measures of children after epilepsy surgery (2.4 years after focal resection) with those of a matched comparison group of nonoperated patients, seizure severity, medication side effects, overall quality of life, general health, physical activity, and well-being were better in surgical patients (70.6% seizure free vs 8.3%). Cognitive, social, and behavioral functioning did not differ, suggesting that these may require additional interventions during postsurgical follow-up.

Relationship between optimism, disease variables, and health perception and quality of life in individuals with epilepsy

Epilepsy is a relatively frequent chronic condition with an important impact on the health perception and quality of life (QOL) of patients. The aim of the present study was to identify variables related to health status perception and QOL in persons with epilepsy. Participants were 200 persons with epilepsy, 53.5% of whom were males. The mean age was 39.6; 95% had seizures, and 99% were taking antiepileptic medication. The self-report questionnaire administered assessed four types of variables: demographic, disease, epilepsy-specific optimistic attitude, and outcome variables. Results demonstrated that an optimistic orientation is related to better perception of physical and mental health status and better perception of QOL. The variables that best predict positive outcomes are optimistic orientation, perception of cognitive functioning, and perception of seizure control. These results question the importance attributed to seizure characteristics for everyday functioning and everyday life of individuals with epilepsy, and stress the importance of facilitating an epilepsy-specific optimistic orientation.

Fatigue: an important feature of late-onset Pompe disease

Objective

To investigate the prevalence and severity of fatigue in adult patients with Pompe disease.

Methods

The Fatigue Severity Scale (FSS) was assessed in an international population of 225 adults with Pompe disease, a metabolic disorder presenting as a slowly progressive proximal myopathy. The FSS scores were compared to those of healthy controls and the relationship between the level of fatigue and other patient characteristics was investigated.

Results

The mean age of the participants was 47 (SD 13) years and the mean disease duration 11 (SD 8) years. 43% used a wheelchair and 46% had respiratory support, 29% needed both. 67% of the participants had a FSS score ≥5, indicating severe fatigue. The mean FSS score was 5.2 (SD 1.5), which was significantly higher than that of healthy controls (p < 0.001). Fatigue was not related to age, sex or disease duration. Patients who used a wheelchair or respiratory support were on average more fatigued than those who did not (p = 0.01). However, of the patients who did not use these aids, 59% also had a FSS score ≥5. FSS scores were highest among patients who reported a high frequency of sleep disorders, but patients who never experienced sleep difficulties were also fatigued (mean FSS score = 4.8).

Conclusion

Fatigue is highly prevalent among both mildly and severely affected adult patients with Pompe disease. The FSS appears a useful tool in assessing fatigue in Pompe disease.

Improvement in quality of life after initiation of lamotrigine therapy in patients with epilepsy in a naturalistic treatment setting

Quality of life is impaired in patients with epilepsy and can be improved by effective therapy. Randomised clinical trials have shown that lamotrigine treatment is associated with improved quality of life. However, little information is available on quality of life or treatment effects in patients with epilepsy in the general population. The objective of this study was to estimate the impact of lamotrigine on quality of life in a naturalistic treatment setting. The study included adult patients with epilepsy in whom lamotrigine therapy was initiated. Each subject completed the Quality of Life in Epilepsy Inventory (QOLIE)-31 quality of life questionnaire at inclusion and at a follow-up visit in the next 4 months. Demographic information and medical history were provided by the investigator. These were evaluated as potential determinants of change in quality of life using logistic regression. Three hundred and forty-one patients were evaluated, 192 starting lamotrigine in combination with another drug, 90 as a first-line monotherapy, 45 as a switch from another drug and 14 as a reduction to monotherapy from a previous combination. Baseline scores on the QOLIE-31 ranged from 53.8 in the combination group to 69.5 in the first-line group. 34.6% of patients were considered to be responders, with no significant differences between treatment regimen. Most improvement was seen for the energy-fatigue and medication effects subscales and, for the first-line group, seizure worry. Seizure type was the only determinant of improvement of quality of life identified. In conclusion, lamotrigine treatment is associated with improved quality of life, regardless of treatment regimen.

Factors affecting the quality of life in childhood epilepsy in China

OBJECTIVES

To explore the level of, and factors affecting the quality of life (QOL) in childhood epilepsy in China.

SUBJECTS AND METHODS

At the Peking University First Hospital, we consecutively identified 418 parents whose children were with known epilepsy to complete a questionnaire, which included children's demographic characteristics, clinical message of epilepsy, QOL, familial message, parental symptoms of anxiety/depression.

RESULTS

Significant (p<0.05) affecting factors of children's quality of life included current educational degree, mental development, age at diagnosis, age at onset, seizure frequency, duration, AED number; parental significant (p<0.05) affecting factors included anxiety, depression and health. On regression analysis, parental anxiety was the most important factor in explaining lower QOL in childhood epilepsy. AEDs, familial economic state, paternal career, seizure frequency were also significant factors.

CONCLUSION

Parental anxiety outweighed the physical factors in determining QOL in childhood epilepsy. Recognition of this will be helpful for professionals to treat disease and improve the QOL of childhood epilepsy.

Sleep disturbances, socioeconomic status, and seizure control as main predictors of quality of life in epilepsy

Improving quality of life is the most important goal for patients with epilepsy. To recognize the factors associated with quality of life in patients with epilepsy in Mexico, we performed a cross-sectional survey using the Quality of Life in Epilepsy 31 (QOLIE-31) inventory to assess the quality of life of 401 adult patients with epilepsy at the National Institute of Neurology and Neurosurgery of Mexico. Clinical and demographical data were collected. Multiple regression was used to determine which factors affected quality of life in our patients. The variables that most strongly predicted a lower QOLIE-31 total score after multiple regression were sleep disorders (P<0.001), socioeconomic status (P<0.001), female gender (P=0.002), and high seizure frequency (P=0.001). In our study, neither depression nor time of evolution of epilepsy had significant influence on QOLIE-31 scores.

El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos

OBJECTIVE

The Short Form-36 Health Survey (SF-36) is one of the most widely used and evaluated generic health-related quality of life (HRQL) questionnaires. After almost a decade of use in Spain, the present article critically reviews the content and metric properties of the Spanish version, as well as its new developments.

METHODS

A review of indexed articles that used the Spanish version of the SF-36 was performed in Medline (PubMed), the Spanish bibliographic databases IBECS and IME. Articles that provided information on the measurement model, reliability, validity, and responsiveness to change of the instrument were selected.

RESULTS

Seventy-nine articles were found, of which 17 evaluated the metric characteristics of the questionnaire. The reliability of the SF-36 scales was higher than the suggested standard (Cronbach's alpha) of 0.7 in 96% of the evaluations. Grouped evaluations obtained by meta-analysis were higher than 0.7 in all cases. The SF-36 showed good discrimination among severity groups, moderate correlations with clinical indicators, and high correlations with other HRQL instruments. Moreover, questionnaire scores predicted mortality and were able to detect improvement due to therapeutic interventions such as coronary angioplasty, benign prostatic hyperplasia surgery, and non-invasive positive pressure home ventilation. The new developments (norm-based scoring, version 2, the SF-12 and SF-8) improved both the metric properties and interpretation of the questionnaire.

CONCLUSIONS

The Spanish version of the SF-36 and its recently developed versions is a suitable instrument for use in medical research, as well as in clinical practice.

Subjective sleep disturbance in patients with partial epilepsy: a questionnaire-based study on prevalence and impact on quality of life

PURPOSE

This study was designed to assess whether sleep disturbance is more frequent among patients with partial seizures and what impact on quality of life (QoL) sleep disturbance may have on patients with partial seizures.

METHODS

Questionnaire booklets were mailed to 1,183 patients from four Dutch clinics. Each patient was asked to find two age- and gender-matched controls to complete the same set of questionnaires [Sleep Diagnosis List (SDL), Medical Outcomes Study (MOS)-Sleep Scale, Groningen Sleep Questionnaire, Epworth Sleepiness Scale, and the SF-36 Health Survey]. The prevalence of sleep disturbance, based on the SDL, was compared between those with partial epilepsy and controls. Mean scores on sleep and the SF-36 Physical (PCS) and Mental (MCS) Component Summary scales were compared.

RESULTS

Responses from 486 patients and 492 controls were analyzed. Respondents with partial epilepsy had a highly significant, twofold higher prevalence of sleep disturbance compared with controls (38.6 vs. 18.0%; p < 0.0001). Most sleep-disorder subscales showed significant abnormalities in respondents with epilepsy, compared with controls. Mean SF-36 MCS and PCS scores were significantly lower in respondents with epilepsy compared with controls in both the strata with sleep disturbance and without (all p values <0.05). The presence of a sleep disturbance in respondents with epilepsy was associated with the greatest impairment in QoL.

CONCLUSIONS

Sleep disturbance is more than twice as prevalent in persons with partial epilepsy compared with controls, and most domains of sleep are significantly disturbed. Persons with partial epilepsy have significant QoL impairment, and sleep disturbance further compounds this.

Changes in quality of life and self-perspective related to surgery in patients with temporal lobe epilepsy

PURPOSE

To evaluate changes in intractable epilepsy patients in terms of quality of life, depression, anxiety, stigma, and impact of epilepsy before and after surgery.

METHODS

Twenty patients with intractable temporal lobe epilepsy who were waiting for surgery (pre-SAH group) and 21 patients who had already undergone surgery (post-SAH group) were studied. All patients received SF-36, Beck Depression Inventory, State-Trait Anxiety Inventory, stigma and impact of epilepsy inventories, and a form asking their own perspectives about epilepsy and surgery.

RESULTS

Post-SAH group scored higher on all subscales of SF-36, with only RE scores being significantly better (t=-1.98, P=.05). Although depression, anxiety, and stigma scores were higher in pre-SAH group, only impact of epilepsy scores were significantly higher in pre-SAH group (t=-2.951, P=.005). Seizure frequency and comorbidity had significant effects on QOL where amount of AEDs and QOL were negatively related (r=-0.318, P<0.05). Both groups stated lack of independence and social activities as the main concern (48.8%) and recovery from epilepsy as the most important expectation from surgery (85.4%). Post-surgical group mentioned the difference in their life after surgery as independence and increase in social activities (47.6%).

CONCLUSION

QOL of patients after surgery was found to be better than before surgery. Results also revealed that seizure frequency, comorbidity, and anti-epileptic medication affected health related QOL negatively. Impact of epilepsy levels was found to be higher among the pre-SAH patients. Finally, independence seemed to be the most important concern and gain for Turkish epilepsy patients.

Health-related Quality of Life of People with Epilepsy Compared with a General Reference Population: A Tunisian Study

PURPOSE

The goal of the study was to assess the health-related quality of life (HRQOL) of persons with epilepsy (PWE) by using the short form survey 36 (SF-36), to compare it with that of a control group and to detect factors influencing it.

METHODS

We collected clinical and demographic data and information on health status by using the Arabic translation of the SF-36 questionnaire from two groups: (a) 120 PWE consulting our outpatient clinic during a period of 4 months, and (b) 110 Tunisian citizens, representative of the Tunisian general population, as a control group.

RESULTS

The mean age of PWE group was 32.74 years, and 45.5% were men. Idiopathic generalized epilepsies were observed in 44.5% of cases, and symptomatic partial epilepsies, in 30%. The most commonly prescribed drug was sodium valproate (VPA). For the SF-36, PWE had lower scores than the control group for only three subscales: general health perception, mental health, and social functioning. Seizure frequency, time since last seizure, and the antiepileptic drug (AED) side effects were the most important variables influencing the HRQOL among PWE. Seizure-free adults have HRQOL levels comparable to those of the control group. Sociodemographic variables had no influence on the SF-36 subscales.

CONCLUSIONS

HRQOL is impaired in Tunisian PWE. The influencing factors identified in this study differ from the previously published data. Several possible reasons such as family support and cultural and religious beliefs are proposed to explain these cross-cultural differences. A larger study should be conducted to verify such findings.

Influence of clinical, demographic, and socioeconomic variables on quality of life in patients with epilepsy: findings from Georgian study

OBJECTIVE

To identify the clinical, demographic, and socioeconomic factors that are associated with a poor quality of life in patients with epilepsy in Georgia.

METHODS

Clinical, demographic, and socioeconomic status data were collected from 115 adult epileptic outpatients being treated in the epilepsy programme at the Sarajishvili Institute of Neurology and Neurosurgery (SINN) in Tbilisi, Georgia. Health Related Quality of Life (HRQL) was measured by the Quality of Life in Epilepsy Inventory (QOLIE-31). Multiple regression analysis was used to determine which variables were associated with QOLIE-31 total and subcomponent scores.

RESULTS

Mean age of the patient population was 37.9 (SD 15.8) years; 43.5% were females; 51.8% did not have a partner; 39.1% had some university education; 82.6% were unemployed. Of 115 epileptic patients 83.3% had partial, and 16.7% had generalised seizures. Overall, 32.2% of patients were seizure free, and 28.7% experienced more than 10 seizures over the past year. The variables that most strongly predicted a lower QOLIE-31 total score were a low education level, high seizure frequency, and long duration of epilepsy. The QOLIE-31 all subcomponent scores correlated strongly with seizure frequency. Advanced age was a significant predictor for a low overall quality of life, energy/fatigue, and cognitive scores. Female sex was the factor that significantly predicted a low seizure worry score. Education level strongly correlated with overall quality of life, and cognitive and social functioning scores.

CONCLUSIONS

Clinical factors such as high seizure frequency and long duration of epilepsy had a significant influence on HRQL. Advanced age, female sex, and a low education level were the demographic factors that correlated strongly with low quality of life scores.

Cross-cultural differences in levels of knowledge about epilepsy

PURPOSE

To study how much people with epilepsy in Europe know and understand about their condition and how this might affect their lives.

METHODS

Clinical, demographic, psychosocial details and information assessing knowledge were collected by using self-completion questionnaires mailed to members of epilepsy support groups.

RESULTS

Data were collected from 6,156 people with epilepsy from ten European countries. There were significant between-country differences in all variables considered. Overall levels of knowledge were acceptable when measured by the epilepsy knowledge questionnaire (EKQ, medical items). However, there were some gaps in knowledge, particularly in issues relating to medication and cause of epilepsy.

CONCLUSIONS

This is the largest study of its kind to date. Results clearly highlighted that levels of knowledge differed significantly between countries. Overall, people with epilepsy are reasonably well informed about epilepsy, although some gaps in knowledge were evident.

Stigma, epilepsy, and quality of life

Despite advances in the understanding and treatment of epilepsy within the past several decades, people with this disorder continue to be stigmatized by it. Though attitudes toward people with epilepsy have improved over the years, for many people with epilepsy, stigma continues to adversely impact their psychological well-being and quality of life. The stigma of epilepsy can be linked to a number of factors, including underresourced medical services, poor seizure control, and inadequate knowledge of epilepsy. Neither informal stigma nor formal discrimination is inevitable for epilepsy patients; however, for many individuals, epilepsy remains a defining feature of their identity, and such issues are a source of considerable concern for a number of patients.

Stigma and epilepsy

For individuals with epilepsy in the United States and other countries, stigma can be one of the most distressing consequences of having seizures, along with the unpredictability of future seizures and the inability to drive. The impact of stigma on the lives of epilepsy patients is far reaching, frequently including effects on interpersonal relationships, general health, employment opportunities, and overall quality of life. Education about epilepsy directed at the broader community, as well as at the individual with epilepsy, is the most effective means of addressing misperceptions and fear. Epilepsy advocacy organizations, such as the Epilepsy Foundation, are important allies in this effort.

Assessing quality of life for adolescents in western Australia

This study investigates the quality of life (QOL) for adolescents residing in Perth, Western Australia. The Quality of Life Profile-Adolescent Version (QOLPAV), a generic self-reported questionnaire, was administered to 363 adolescents aged between ten and 18 years who were enrolled in 20 high schools within metropolitan Perth. Stepwise regression analysis of the data showed that age, control, opportunity and perceptions of health have significant associations with QOL. It was also found that adolescents with a chronic condition and those without have similar QOL scores. This suggests that, in terms of QOL, the chronically ill adolescents do not view themselves as different from their healthy counterparts.

Quality of life in patients with epilepsy and impact of treatments

Epilepsy is a chronic condition with numerous social and psychological consequences. This work aimed to review available data on epilepsy and the impact of surgical and pharmaceutical treatments on the quality of life in adults and children. Research on quality of life in epilepsy is characterised by a wide and fragmentary range of methodology, both in terms of study design and instruments used. Quality of life is worse in patients with epilepsy than in the general population; it is comparable or worse in patients with epilepsy than that in patients with other chronic conditions; and it is similar to that of healthy persons when patients with epilepsy are well-controlled. Frequency of seizures seems to be one of the most relevant determinants of poor quality-of-life (QOL) scores, and quality of life is worsened by the co-existence of depression. The impact of surgical treatment on quality of life is positive, in all ages, in correlation with seizure control. There is no exhaustive or even contradictory results available concerning the impact of drug treatment. Role activities, emotional status and cognition have been the most investigated domains of quality of life in epilepsy research. There is a substantial lack of information regarding the functional status domain. At present, quality of life and psychosocial functioning in people with epilepsy have been investigated in many studies. Nevertheless, the lack of a standardised approach makes it extremely difficult to summarise and indicate what measures should be used, in which patients, and in which sub-populations. In the pursuit of developing valid, reliable and sensitive measures of quality of life, it seems no longer appropriate to consider seizure frequency alone.

Predictors of good compliance in adolescents with epilepsy

The purpose of this paper was to describe the factors that predict compliance in adolescents with epilepsy. Altogether 300 individuals aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (N= 232 ) of the selected adolescents with epilepsy returned the questionnaire. The data were analysed with SPSS software. Using the logistic regression model, the compliance of adolescents with epilepsy was predicted on the basis of support from physician and parents, motivation and the disease not being a threat of social well-being. The most powerful predictor was support from the physician. The likelihood of adolescents supported by their physicians complying with their health regimens was 10.56-fold compared with the adolescents who did not receive support from their physicians. Another powerful predictor was support from parents. The adolescents who received support from their parents complied with the health regimens with a 10.47-fold likelihood compared with adolescents who did not receive support from their parents. Adolescents with good motivation were 9.77 times more likely to comply than adolescents who did not have good motivation. Adolescents who did not feel the disease to be a threat to their social well-being complied with health regimens with an 8.38-fold likelihood compared to those who felt the disease to be a threat to social well-being. The value of the -2Log likelihood was 64.68 and the goodness of fit index was 214.735. The value of Nagelkerke was 0.893, which indicates that the logistic regression model explains 89% of the variance. The model predicts correctly 97% of compliance in adolescents showing good compliance. These values show the logistic regression model to be good and to match well with the data.

Compliance with health regimens of adolescents with epilepsy

The purpose of this paper was to describe the compliance of adolescents with epilepsy and some factors connected to it. Altogether 300 individuals with epilepsy aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (n= 232) of the selected adolescents with epilepsy returned a questionnaire sent to them relating to compliance. The data were analysed using the SPSS software. Twenty-two per cent of the adolescents with epilepsy felt that they complied fully with their suggested health regimens, while 44% placed themselves in the category of "satisfactory compliance", and the remaining 34% reported poor compliance. Compliance with their recommended life-style was poorest, while the highest degree of compliance was recorded for medication. Background variables, such as the duration of the disease, exercise, smoking, alcohol-intake and the number of seizures, were statistically significantly related to compliance (P< 0.001). Good motivation, a strong sense of normality, experience of results, subjective outcome, energy and will-power, support from parents, physicians and nurses, and a positive attitude towards to the disease and its treatment, no threat to social and emotional well-being and no fears of complications and no fear of seizures explained good compliance (P< 0.001).

The SF-36 as a health status measure for epilepsy: a psychometric assessment

A considerable literature is now available on the applications and psychometric properties of the MOS SF-36 Health Survey. In epilepsy, the SF-36 has been used as a health status measure in its own right and as the stem for two condition-specific measures. This paper replicates for epilepsy previous work to support use of the SF-36 across a range of clinical conditions. Data were obtained from a European-wide descriptive study of quality of life of adults with epilepsy; analysis of responses on the SF-36 is based on 4,929 subjects in eight countries. Missing value rates for all SF-36 items were low; percentages for whom complete information available for subscales ranged from 95.7% to 98.6%. All subscales passed tests for item-internal consistency and item-discriminant validity. Reliability coefficients exceeded the standard recommended for group comparisons across all subscales. Floor effects were negligible for all but the two role disability subscales; there were substantial ceiling effects for five of the SF-36 subscales. We conclude that the SF-36 is a valid and reliable health status measure for descriptive studies of people with epilepsy, but ceiling effects may limit its usefulness as an outcome measure in the assessment of new treatments.