A Study Of The Change Of Quality Of Life In Epilepsy Patients And Its Affecting Factors

As a common chronic disease of neurology,epilepsy severely affects patients' quality of life.Facts which were considered to be impotant are seizure frequency,seizure type,adverse effect of antiepileptic drugs,depression and stigma.In terms of several questionnaires,the article compared the baseline data on quality of life in people with epilepsy with the date received after a period of follow-up in order to investigate if there was a trend and what the main factor that affected the trend.PartⅠThe change of quality of life in epilepsy patients and multiple analysis of its affecting factorsPurpose:Investigate the difference of quality of life through a period of time during which patients with epilepsy received standardized diagnosis and treatment.Investigate the factors affected the difference.Material and methods:305 patients enrolled in the study,among which 149 patients were responders.283 patients received their baseline evaluation on quality of life and 138 patients received their evaluation after a period of follow-up.The questionnaires we ultilize are:adverse effect profile(AEP),quality of life in people with epilepsy-31(QOLIE-31) ,self-rating anxiety scale(SAS),Hamilton depression scale(HAMD) ,scale of knowledge and attitude toward epilepsy.Results:1.Adverse effects of antiepleptic drugs:AEP total score is 36.1±7.68 at baseline and 34.22±10.55 at follow-up and there was no significant difference(P value is 0.09,n=53).Among 20 listed adverse effects, only for and the score at follow-up is highter than the score at baseline and there were significant differences(P value is 0.022 and 0.014 respectively).2.Anxiety:the incidence of anxiety is 7.5%at baseline(n=105) and 4.0% at follow-up(n=148).SAS score is 31.75±6.1 at baseline and 31.68±7.27 at follow-up and there was no significant difference(P value is 0.924).3.Depression:the incidence of depression is 7.1%at baseline(n=126) and 3.6%at follow-up(n=139).At baseline,median of HAMD score is 2.5 and 25,75 percentile is 1.00,7.50 respectively.At follow-up, median of HAMD score is 5 and 25,75 percentile is 1.25,8.00 respectively.There was significant differeance(P value is 0.025, n=68).4.Stigma:Stigam score is 3.04±1.58 at baseline and 2.81±1.86 at follow-up and there was no significant differeance(P＞0.05).5.QOL:QOLIE-31 total score is 64.09±16.63 at follow-up which is significantly higher than baseline 61.30±15.52(P value is 0.037, n=138)6.Multiple analysis of difference between baseline and follow-up:The difference of QOLIE-31 total Score is negatively correlated with adverse effects of AEDs and depression.The difference of Seizure worry score is negatively correlated with anxiety and polytherapy and people who have jobs tend to get less differences of scores on seizure worry than the unemployed.Overall quality of life score is correlated with types of seizure and people with generalised epilepsy tend to get less differences of scores on overall quality of life.The differences of scores on energy and emotion are negatively correlated with depression. The differences of scores on social and cognitive function are negatively correlated with adverse effects of AEDs.Male patients tend to get less difference on score of medication effects(n=138).Conclusions:1.Quality of life in people with epilepsy did improve through standardized procedure of diagnosis and treatment.2.Adverse effects of AEDs and depression are the two main factors limited such improvement. PartⅡEvaluation of effectiveness and impact on quality of life of lamotrigine,valproate and carbamazepine for monotherapy of newly diagnosed epilepsyPurpose:Evaluate the effectiveness of lamotrigine,valproate and carbamazepine and investigate differences of effects on quality of life, adverse effects of AEDs,depression,anxiety and stigma among the three firstline antiepileptic drugs.Material and methods:107 newly diagnosed patients with epilespy enrolled in the study,among which 64 patients were responders.Patients whose seizure frequency decrease above 50%are considered to be in the effective group.The questionnaires we ultilize are:adverse effect profile(AEP) ,quality of life in people with epilepsy-31(QOLIE-31),self-rating anxiety scale(SAS),Hamilton depression scale(HAMD),scale of knowledge and attitude toward epilepsy and mini mental stae examination (MMSE).Results:1.Effectiveness:The percentage of frequecy decrease above 50%is 80% for lamotrigine,75%for carbamazepine and 69.6 for valproate and there is no significant difference(P value＞0.05),2.Cognitive funtion" MMSE score for lamotrigine group was 27.92±4.63 at baseline and 29.54±0.66 at follow-up.MMSE score for carbamazepine group was 28.79±1.93 at baseline and 28.07±2.59 at follow-up.MMSE score for valproate group was 28.33±1.94 at baseline and 28.22±2.24 at follow-up.There was no differcence either between baseline and follow-up or among three groups(P value＞0.05).3.Quality of life:QOLIE-31 total score for lamotrigine group was 64.31±12.10 at baseline and 70.11±9.93 at follow-up.QOLIE-31 total score for carbamazepinegroup was 59.87±11.16 at baseline and 65.33±11.24 at follow-up.QOLIE-31 total score for valproate group was 66.95±12.89 at baseline and 72.45±16.93 at follow-up.There was no differcence either between baseline and follow-up or among three groups(P value＞0.05).4.Other factors affecting quality of life:AEP score was 33.00±8.56, 34.71±9.09,31.78±8.33 for lamotrigine,earbamazepine and valproate group respectively at follow-up and there was no siginificant difference(P value＞0.05).SAS score was 30.08±5.62,34.07±8.23,33.28±17.52 for lamotrigine,carbamazepine and valproate group respectively at follow-up and there was no siginificant difference (P value＞0.05).HAMD score was 7.31±4.21,5.36±4.85,2.56±2.71 for lamotrigine,carbamazepine and valproate group respectively at follow-up and there was significant difference between valpoate group and lamotrigine group.Conclusions:1.The effectiveness for lamotrigine is not lower than carbamazepine and valporate for newly diagnosed patients with epilepsy. 2.No significant difference is found among lamotrigine,carbamazepine and valproate for effects on quality of life of newly diagnosed peolple with epilepsy.