Quality of life among people with epilepsy and mild intellectual disabilities in residential care

Quality of life predictors in patients with epilepsy and cognitive disabilities

Purpose We aimed to assess the QOL and its predictors in Bulgarian patients with refractory epilepsy (RE) and cognitive problems.

Methods We conducted a study based on questionnaires designed for people with intellectual disability (the stigma scale, the Glasgow Depression Scale, the Glasgow Anxiety Scale, the Glasgow Epilepsy Outcome Scale – GEOS-35) and a purposeful interview on clinical and social factors of 64 patients (50% men) with RE and cognitive problems.

Results The mean total score of the GEOS-35 was 76 ± 2.34 (an indicator of low QOL). On univariate analysis, the GEOS-35 total score was associated with seizure frequency and severity, stigma, depression, and anxiety. On multivariate regression analysis predictors of the GEOS-35 total score were anxiety, seizure severity, and stigma Р < 0.001 (F = 14.66). Regarding the GEOS-35 subscales, on multivariate regression analysis, we found that 1. Seizure severity, seizure type, and anxiety were predictors of “concerns about seizures” Р < 0.001 (F = 8.99); 2. Anxiety was the only predictor of “concerns about treatment” Р < 0.001 (F = 7.98); 3. Anxiety and seizure severity were predictors of “concerns about caring” Р < 0.001 (F = 12.12); and 4. Seizure severity and stigma were predictors of “concerns about social impact” Р < 0.001 (F = 18.31).

Conclusions We have affirmed the low QOL in patients with RE and cognitive problems and its clinical and social determinants. The results from our study prove the necessity of a multidisciplinary approach for quality of life improvement in these patients.

Predictors of health-related and global quality of life among young adults with difficult-to-treat epilepsy and mild intellectual disability

OBJECTIVE

This study evaluated predictors of health-related quality of life (HRQOL) and global quality of life (QOL) among young adults with difficult-to-treat epilepsy and mild intellectual disability.

METHODS

One hundred and forty-two persons with epilepsy and cognitive problems were routinely screened on HRQOL, global QOL, and psychological distress four weeks after admission to a time-limited residential rehabilitation unit. The PESOS scales (PE = PErformance, SO = SOciodemographic aspects, S = Subjective evaluation/estimation) on epilepsy-specific problems were administered as measures of HRQOL; a questionnaire on life satisfaction and an item on overall QOL were used as measures of global QOL. Psychological distress was captured with the Symptom Checklist 90-R. Further data were gained from medical files. Quality-of- life predictors were identified using univariate methods and stepwise regression analyses.

RESULTS

Psychological distress was the only predictor of all HRQOL and global QOL parameters. Seizure frequency was a predictor of most HRQOL variables. Other epilepsy variables affected only some HRQOL variables but were not associated with global QOL. Health-related quality of life did not seem to be strongly impaired. Only low correlations were found between HRQOL and global QOL.

CONCLUSION

The notion of psychological distress as the most influential predictor of all QOL measures is in line with most findings on QOL in epilepsy. Former observations of weak associations between HRQOL and global QOL among patients with epilepsy and mild intellectual disability are supported. Thus, interventions to reduce psychological distress, besides epilepsy treatment, seem to be of great importance to improve QOL.

Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review

PURPOSE

Given the high burden of epilepsy on both health-related quality of life (HRQoL) and costs, identification of factors that are predictive of either reduced HRQoL or increased expenditure is central to the better future targeting and optimization of existing and emerging interventions and management strategies for epilepsy.

METHODS

Searches of Medline, Embase, and Cochrane Library (up to July 2010) to identify studies examining the association between demographic, psychosocial, and condition-related factors and HRQoL, resource utilization or costs in adults with epilepsy. For each study, predictor factor associations were summarized on the basis of statistical significance and direction; the results were then combined across studies.

KEY FINDINGS

Ninety-three HRQoL and 16 resource utilization/cost studies were included. Increases in seizure frequency, seizure severity, level of depression, and level of anxiety and presence of comorbidity were strongly associated with reduced HRQoL. The majority of studies were cross-sectional in design and had an overall methodologic quality that was judged to be "moderate" for HRQoL studies and "poor" for health care resource or costs studies. In the 53 multivariate studies, age, gender, marital status, type of seizure, age at diagnosis, and duration of epilepsy did not appear to be associated with HRQoL, whereas the predictive influence of educational and employment status, number of antiepileptic drugs (AEDs) and AED side effects was unclear. The association between predictive factors and HRQoL appeared to be consistent across individuals whether refractory or seizures controlled or managed by AEDs. There were insufficient multivariate studies (five) to reliably comment on the predictors of resource utilization or cost in epilepsy.

SIGNIFICANCE

In addition to seizure control, effective epilepsy management requires the early detection of those most at risk of psychological dysfunction and comorbidity, and the targeting of appropriate interventions. There is need for more rigorous studies with appropriate multivariate statistical methods that prospectively investigate the predictors of HRQoL, resource utilization, and costs in epilepsy.

Self-proxy agreement and correlates of health-related quality of life in young adults with epilepsy and mild intellectual disabilities

This study investigated health-related quality of life (HRQOL) in young adults with epilepsy and intellectual disabilities. First, agreement between self-reports and proxy reports of HRQOL was examined. Second, medical and psychological contributions to HRQOL were explored. Thirty-six patients were interviewed using the Quality of Life in Epilepsy inventory (QOLIE-31), the Hospital Anxiety and Depression Scale, and the Neuroticism and Extraversion scales of the NEO Five-Factor Inventory. Medical data were taken from files. Professional caregivers completed rephrased QOLIE-31-questionnaires. The perspectives on HRQOL differed systematically: Caregivers underrated their clients' HRQOL on average. Few correlations with medical characteristics emerged, whereas all psychological variables were strongly related to HRQOL. Neuroticism, Age at Disability Onset, and their interaction explained 71% of the HRQOL variance. Results indicate that proxy reports do not provide valid substitutes for most of the self-reported HRQOL subscales. Psychological treatment of negative affectivity and after critical life events in adolescence may improve HRQOL in young adults with epilepsy and mild intellectual disabilities.