Advances in the measurement of health-related quality of life in epilepsy

Quality of Life Assessment in Multiple Sclerosis: Different Perception between Patients and Neurologists

Background

In recent years, neurologists are noticing that evaluation of multiple sclerosis (MS) patients based on combining relapses, disability progression, and magnetic resonance imaging activity may be insufficient to adequately assess suboptimal responses to available therapy. Inclusion of quality of life (QoL) parameters may contribute to breach this gap.

Objective

To evaluate agreement levels between doctor and patient perception of QoL in MS.

Methods

A total of 700 MS patients and 300 neurologists were invited to participate in a cross-sectional study by answering an e-mail questionnaire. The survey collected information on demographical data and included the Short Form questionnaire (SF-36). After completing the questionnaire, patients were given a standard written description of each of the subdomains assessed by SF-36 and asked to identify which three were the most important determinants of their overall health-related QoL.

Results

A total of 135 neurologists and 380 MS patients responded the survey. Study population mean age was 42.1 ± 10.5 years, with 61% presenting relapsing-remitting MS. SF-36 results were physical function 68.4 ± 30, physical role limitation 56.8 ± 41.7, vitality 47.6 ± 21.4, pain 71.2 ± 26.1, social function 72.6 ± 28.6, emotional role limitation 63.2 ± 39.8, mental health 60 ± 14.1, and general health 55.8 ± 22. Doctors considered physical function (75%) and physical role limitation (70%) as the most important QoL determinants in MS, followed by emotional role limitation (52%). Patients however, assigned significantly different levels of importance to physical function (58%), and physical role limitation (46%) and considered vitality (52%) more important than their physicians (p < 0.001). Important to note, the results of SF-36 questionnaire were highly correlated with the perception gap between patients and neurologists (r = 0.89; p = 0.0004).

Conclusion

Concerns on QoL in MS are different for patients and physicians. It is essential to enhance communication in order to better understand actual patient needs.

In Vitro Performance of Carbamazepine Loaded to Various Molecular Weights of Poly (D, L-Lactide-Co-Glycolide)

The purpose of this study was to develop and assess the in vitro characteristics of carbamazepine-loaded microspheres. A solvent evaporation method was used to incorporate carbamazepine (CBZ) into poly (D,L-lactide-co-glycolide) (PLGA) with different molecular weights. The optimum conditions for CBZ-PLGA microspheres preparation were considered and the in vitro release of CBZ of PLGA microspheres were followed up to 24 hr in USP dissolution medium. The effect of using different ratios of PLGA microspheres, prepared with different molecular weights, for optimizing CBZ release also was investigated. CBZ encapsulation efficiency was 68 to 82% for all prepared formulations. Thermograms of CBZ-PLGA microspheres suggest that CBZ was totally entrapped with the PLGA polymer. The presence of Pluronic F-68 has improved the encapsulation of CBZ, resulted in better and smoother microspheres surfaces and enhanced its release pattern. CBZ release profiles were biphasic patterns; after an initial burst, a constant CBZ release rate was observed up to 24 hr. The release from these PLGA-based spherical matrices was consistent with the diffusion mechanism. CBZ dissolution T(50%) was significantly affected (> 3-fold) by increasing the lactide percent from 33.3 to 66.6% from different microspheres mixtures. The present study provides evidence that the encapsulation of CBZ to PLGA microspheres, either as a single polymer or mixture of two, was a successful attempt to control the release of CBZ.

Long-term seizures and quality of life after epilepsy surgery compared with matched controls

OBJECTIVE

We compared long-term seizure outcome and health-related quality of life (HRQoL) of patients who underwent epilepsy surgery and matched medically treated nonsurgical controls with intractable epilepsy.

METHODS

Medically treated controls were identified for patients operated on for epilepsy between January 1, 1949 and December 31, 1992. We used a matched cohort design, matching for age, sex, and seizure type. The analysis was based on 70 complete matching pairs. HRQoL was assessed with the Quality of Life in Epilepsy Inventory 89 questionnaire an average of 15 years after surgery.

RESULTS

Among surgery patients, 48% were seizure-free during the previous year compared with 19% of the controls (P = 0.0004). Fewer surgery patients used antiepileptic drugs (70%) than controls (93%). The odds of being seizure-free were higher for surgery patients in total and in subgroups divided according to length of follow-up. The mean HRQoL for surgery patients was higher in five of the 17 Quality of Life in Epilepsy Inventory 89 dimensions and worse in none. Among patients with more than 7 years of follow-up, HRQoL was better in three dimensions and worse in none. Among patients with 7 years of follow-up or less, HRQoL was better in two dimensions and worse in the language dimension of the Quality of Life in Epilepsy Inventory 89.

CONCLUSION

After an average of more than 15 years of follow-up, epilepsy surgery patients had fewer seizures, used less antiepileptic medication, and had better HRQoL in several dimensions of the Quality of Life in Epilepsy Inventory 89 instrument than matched medically treated controls with refractory epilepsy, although possibly at a slight disadvantage in the language dimension among those with 7 years of follow-up or less.

Quality of life and comorbid medical and psychiatric conditions in temporal lobe epilepsy

Patients with epilepsy frequently report dissatisfaction with their quality of life (QOL), and there is considerable interest in understanding the factors and mechanisms associated with this perception. To date, investigation has focused on the potential contribution of seizure variables (e.g., seizure control) and psychiatric conditions to QOL, but there has not been an examination of the potential role of comorbid medical conditions. Information was gathered concerning current medical and psychiatric conditions for 93 patients with temporal lobe epilepsy, and their relationship with QOL was examined. The numbers of medical and psychiatric conditions were distinct and significant predictors of QOL satisfaction, and both were stronger correlates than seizure-related factors and demographic variables. The implications of these findings for the treatment and management of patients with epilepsy are discussed.

The Relative Impact of Anxiety, Depression, and Clinical Seizure Features on Health-related Quality of Life in Epilepsy

PURPOSE

To determine the independent effects of depression and anxiety on health-related quality of life (HRQOL) in epilepsy as well as the relative explanatory power of psychiatric comorbidity compared with demographic and clinical epilepsy variables (e.g., seizure frequency, severity, and chronicity).

METHODS

Subjects (n = 87) with temporal lobe epilepsy completed self-report measures of depression, anxiety, HRQOL, and seizure severity. Information was derived regarding subjects' seizure frequency, duration, and treatment. HRQOL status (QOLIE-89) was examined in relation to self-reported symptoms of anxiety and depression, clinical seizure features, and demographic characteristics.

RESULTS

Depression and anxiety were independently associated with reduced HRQOL. Psychiatric comorbidity explained more variance in HRQOL than did combined groups of clinical seizure or demographic variables. Although weaker in explanatory power than psychiatric comorbidity, several epilepsy factors were nonetheless significantly related to HRQOL, including seizure frequency, severity, and chronicity.

CONCLUSIONS

Interictal anxiety and depression exert independent adverse effects on HRQOL. In addition, frequent, severe, and chronic seizures reduce HRQOL, but appear less powerful predictors of HRQOL than interictal psychiatric symptoms. Recognition and treatment of comorbid depression and anxiety is an important consideration in improving quality of life in epilepsy.

Effects of epilepsy surgery on quality of life: a controlled study in a Middle Eastern population

The purpose of this study was to investigate which areas of quality of life (QOL) change after epilepsy surgery and generate QOL data specific to the Lebanese population. The QOL of 20 consecutive patients 1 year after surgery was compared (using the ESI-55 scale) with that of 20 matched patients who underwent the same presurgical evaluation, but no surgery. Overall QOL improved in both groups, but was greater in the surgery group (85% seizure free as compared to 0% in nonsurgery group). Significant differences were noted within the "well-being" domain including health perception (5/9 items), energy-fatigue (2/4), and emotional well-being (2/5). Differences were less common in the "functioning" domain including physical (1/10 items), social (1/2), and cognitive (0/5) functioning scales, and in the role limitation domain (1/17 items). Our patients experienced, 1 year after epilepsy surgery, improvements similar to those reported in Western populations after a similar period: they had marked improvements in overall QOL, health perception, well-being, and cognitive functioning areas. They had less remarkable improvements in social functioning and role limitation areas.

Clinical guidelines for the management of epilepsy in adults with an intellectual disability

Clinical guidelines exist for the treatment of chronic epilepsy and epilepsy in women (2). This publication provides guidance for the clinician investigating and managing epilepsy in adults who have an intellectual disability as defined by an Intelligence Quotient (IQ) of less than 70, onset in the developmental period and difficulties with adaptive functioning.

Epilepsy and intellectual disability

A Medline and Psychline literature review of epilepsy in people with intellectual disability was performed. The review has highlighted the importance of the impact of epilepsy on the lives of individuals and their families, affecting physical morbidity, leading to an increased mortality and increasing the care-giving burden. Interventions with a strong evidence base are mainly pharmacological with an increasing body of work on the novel antiepileptic drugs. Surprisingly little research exists into the quality of service provision for this population. The authors suggest three areas for future work: (1) an increasing application of research methodologies such as direct observation and qualitative studies into this field; (2) an exploration of the broad impact of treatment and (3) the possibility that epilepsy is a barrier to care provision.

Comorbid psychiatric symptoms in temporal lobe epilepsy: association with chronicity of epilepsy and impact on quality of life

Purpose. The goals of this work were to determine: (1) the nature and extent of differences in self-reported psychiatric symptoms between patients with temporal lobe epilepsy and matched healthy controls, (2) the relationship between chronicity (duration) of temporal lobe epilepsy and comorbid interictal psychiatric symptoms, and (3) the impact of comorbid psychiatric symptoms on self-reported health-related quality of life. Methods. Patients with temporal lobe epilepsy (n = 54) and healthy controls (n = 38) were administered the Symptom Checklist-90-Revised (SCL-90-R) to assess the nature and severity of psychiatric symptomatology and epilepsy patients completed the Quality of Life in Epilepsy-89 (QOLIE-89) to define health-related quality of life. Among epilepsy patients the SCL-90-R scales were examined in relation to chronicity of temporal lobe epilepsy as well as the impact of comorbid emotional-behavioral distress on health-related quality of life. Results. Compared with healthy controls, patients with epilepsy exhibited significantly higher (worse) scores across all but one of the 12 SCL-90-R scales. Among patients with epilepsy, increasing chronicity was associated with significantly higher (worse) scores across all SCL-90-R scales and increased emotional-behavioral distress was associated with lower (worse) scores across all 17 QOLIE-89 scales. Conclusion. Comorbid interictal psychiatric symptoms are elevated among patients with temporal lobe epilepsy compared with healthy controls and appear to be modestly associated with increasing chronicity (duration) of epilepsy. This comorbid emotional-behavioral distress is specifically associated with a significantly poorer health-related quality of life, and suggests that quality-of-life research should devote greater attention to the potential impact of comorbid psychiatric distress.

Impact of epilepsy on QOL in a Portuguese population: exploratory study

OBJECTIVES

To develop an outcome measure of QOL (quality of life) for the Portuguese population; describe QOL in epileptics; analyse how QOL is affected by epilepsy and analyse how QOL is affected by patients' characteristics.

PATIENTS AND METHODS

Study of a consecutive sample of 92 epileptics from an outpatient clinic, men and women, aged 15-65, having the basic education level. Firm diagnosis of epilepsy (with or without seizures) without other illness. A questionnaire based on ESI-55 and Health Insurance Experiment Short-Forms was used. Principal component analysis (orthogonal varimax) showed a solution explaining 55.6 of total variance. After the inspection, the 33 items were grouped into 5 sub-scales (dimensions).

RESULTS

Results showed that QOL was poor for people with partial seizures. The best scores were found on patients now free from seizures.

CONCLUSION

The QOL measure is sensitive to cultural differences, demographic and disease variables which could explain the results found.

Influence of vigabatrin on cognitive performances and behaviour in patients with drug-resistant epilepsy

INTRODUCTION

The aim of this research was to evaluate changes in cognitive performances, mood and quality of life in drug-resistant epileptic patients, after the introduction of Vigabatrin (VGB) as additional treatment.

MATERIAL AND METHODS

A four-step evaluation was carried out in two groups of 20 patients each, randomly assigned to VGB or placebo treatment. A battery of neuropsychological tests investigating attention, memory and adaptive abilities, associated with inventories concerning depression, quality of life and the concern of families upon patient behaviour, were utilised. For each subject, four evaluations were performed, two before and two after VGB/placebo administration.

RESULTS

No relevant side-effects regarding cognition and behavior were detected in the VGB group. The intra-group comparison between pre- and post-treatment phases showed a slight improvement in cognitive performances of VGB patients and a positive change in their overall psychological status. The inter-group comparison confirmed the selective improvement occurring in the trend of a few neuropsychological test scores in the VGB group.

CONCLUSION

Such results help to reject the hypothesis that the addition of VGB to the current antiepileptic treatment may affect cognitive performances and behaviour.