Study Of The Neuropsychological Characteristics And Quality Of Life Of Adult Patients With Epilepsy

Epilepsy is a disorder of the brain characterized by an enduring predisposition togenerate epileptic seizures and by the neurobiologic, cognitive , psychological andsocial consequences of this condition (ILAE & IBE 2005). Statistics show that themorbidity rate of epilepsy in China is about 7‰, About 900 million patientsnationwide, and increasing 45 million per year. The prevalence of active epilepsy is4.6‰(two or more unprovoked seizures within 12 months). Of the people withepilepsy, 40.6% have not been treated, 35.4% are treated irregularly, and thetreatment gap of active epilepsy is 62.6%. The prognosis for the majority of patientsis good, but more than 30% do not have remission despite appropriate therapy withantiepileptic drug. The results are substantial effects on individual quality of life andneuropsychological impairment.Neuropsychological impairment is an important comorbidity of chronic epilepsy,including cognitive function, depression and so on. Cognitive disorders are a commoncomplaint in patients with epilepsy, different variables have been identified aspotential risk factors for cognitive decline in patients with epilepsy, but it is not clearif there are changes of progression among the subjects with seizure-free epilepsy anddepression in epilepsy exacerbate the cognitive deficits. Depression is the mostcommon psychiatric comorbidity associated with epilepsy. Because the clinicalpresentation is atypical and does not meet DSM-IV and DSM-IIIR diagnostic criteria,and traditional belief that antidepressants should be restricted because of a supposeddecrease in seizure threshold, underdiagnosis and undertreatment are major problems. Early identification and treatment of neuropsychological impairment may improvehealth outcomes in persons with epilepsy.Quality-of-life (QOL) concerns an individual's satisfaction with all facets of lifeincluding physical, social and psychological well-being. Epilepsy is a chronic diseasewith broad effects on QOL. It has been shown that the most important factorsaffecting QOL in epilepsy are the epilepsy itself, psychiatric comorbidity (e.g.depression and anxiety) and social complications. Although patients "seizure-free" isthe ultimate goal of treating persons with epilepsy, many patients have long-term poorQOL outcomes despite seizure controled, suggesting that socio-psychological factorcan continue to progress even in the seizure-free. It is widely known that the aim oftreating epilepsy is not necessarily seizure-controlled but improvement of patients'QOL. This study includes the following three cross-sectional designs:PartⅠNeuropsychological characteristics in adults withepilepsy and its risk factorsObjectiveTo assess the neuropsychological characteristics in adult epileptic patients andinvestigate its risk factors.MethodsNinety adult epileptic patients included 60 active epileptic patients (two or moreunprovoked seizures within 12 months) and 30 age-, sex-, education-, course ofdisease- and seizure type-matched seizure-free subjects (without epileptic seizure forat least 1 year). The neuropsychological tests included Trail making test, Digit symboltest, Verbal fluency test, Digit span test and Hamilton Depression Scale(HAMD),were used to detect mental and motor speed, attention, language, working memoryand depression symptoms respectively. We compared the neuropsychological tests between active and seizure-free epileptic patients and identified the risk factors ofneuropsychological deficits in active epileptic patients.Results1. Compared to seizure-free subjects, active epileptic patients had significantlyworse scores in Digit symbol test(47.45±18.812 vs 56.40±13.631), Verbal fluencytest(25.25±8.163 vs 30.40±8.414), Digit span test (10.39±2.228 vs 11.80±2.074)respectively; took significantly more time to accomplish the Trail making testA(64.35±31.710 vs 45.47±16.309)s and B(133.18±47.331 vs 98.00±35.003)srespectively; and had significantly higher scores on depressive symptoms(9.12±6.219 vs 3.77±3.997)(all P<0.05).2. Within active epileptic group, significant predictors of neuropsychologicaldeficits were identified in a stepwise linear regression analysis: Advancing age wassignificantly negatively correlated with Digit symbol test(β=-0.468,P=0.000), Digitspan test (β=-0.439,P=0.000), Trail making test A (β=0.365,P=0.003) and B(β=0.346,P= 0.002); higher scores on depressive symptoms was significantly negativelycorrelated with Digit symbol test (β=-0.244,P=0.015); mental work, high-educationlevel and monotherapy were positively correlated with some of the cognitive functionsubscales.Conclusions1. This study suggests that active epilepsy can have a direct adverse effect oncognition and depression symptoms. Multi-drug therapy, severity of depressionsymptoms, advancing age, low-education level and non-mental work are thepredictors of neuropsychological impairment in active epilepsy.2. Good seizure control even after 1 year can have a beneficial impact oncognitive and depression prognosis. PartⅡRisk factors for depression in adults with epilepsyObjectiveTo investigate the prevalence of adult epileptic patients with depressivesymptoms and identify early predictors of depressive symptoms.MethodsAdult patients with epilepsy were recruited (n=110, 45 females), age between 16and 67 years(median28.29±11.323 years). The sociodemographic and clinical factorsof patients were recorded. Hamilton Depression Scale (HAMD) were applied toevaluate patients depression in remission (at least 72 hours after the last epilepticseizure). According to HAMD score, the epileptic patients were divided intodepressive (≥8) and non-depressive (<8) groups. we compared the sociodemographicand clinical factors between the two groups to identify the prevalence and earlypredictors of depressive symptoms in adult epileptic patients.Results1. The prevalence of depressive symptoms in adult patients with epilepsy was38.2%, 49% in active epilepsy and 12.1% in remission. 30%, 5.5%, and 2.7% wereexperiencing mild-to-moderate (HAMD score≥8), moderate-to-severe (≥18) andsevere (≥25) depression.2. With multiple stepwise backward Logistic regression, independent predictorsof depression were epileptic seizures (OR=8.845, P=0.003), symptomatic orcryprogenic epilepsy (OR=3.132, P=0.045), prolonged duration of illness (OR=1.106,P=0.004) and employment status (OR=0.154, P=0.001).3. No differences in changer of seizure frequency and depressive symptoms wererevealed with Kruskal Wallis Test.Conclusions1. Depressive symptoms is a frequent psychiatric comorbidity in adult patients with epilepsy. The prevalence of depressive symptoms is high in those with activeepilepsy compared with those in remission and most of them are mild-to-moderate.2. Epileptic seizures, symptomatic or cryprogenic epilepsy, prolonged duration ofillness and employment status are independent predictors of depressive symptoms.3. Seizure frequency have nothing to do with the depressive symptoms severityof patients .PartⅢRisk factors for quality of life in adults with epilepsyObjective1. To assess the impact of different clinical and demographic variables,depression, stigma and perceived social support on quality of life in adults withepilepsy, and to identify the variables predictive of poor quality of life.2. To compare the QOL between active and seizure-free epileptic patients.Methods116 adults with epilepsy were enrolled in this study, whose age between 16 and67 years (median 37.75±13.661 years), males 57.3%. Patients completed HAMD,Three-item stigma scale, Perceived Social Support Scale (PSSS) and Quality of Lifein Epilepsy Inventory-31 (QOLIE-31). Pearson's Correlation was used to explore thedepression, stigma and perceived social support associated with QOLIE-31 overalland subscale scores, and Multiple Regression Analysis to identify the variablespredictive of poor QOL.Results1. 61.3% of people with epilepsy fe lt stigmatized and 12.1% weresevere(1.06±1.049); The prevalence of depression was 37.1% (HAMD≥8) (median6.90±6.027); perceived social support total and three subscales scores were61.00±11.392, 22.28±3.918 (family support), 18.94±5.303 (friend support), 19.87± 4.682 (Significant support) respectively.2. 37(31.9%) of patients had no seizure in the past year. Compared to activeepileptic patients, seizure-free subjects had higher scores in Seizure worry(50.08±8.477 vs 44.90±10.090), General QOL (51.16±10.057 vs 46.52±11.278),Cognitive function (51.35±10.056 vs 45.53±11.229), Medication effects (54.92±7.037 vs 47.16±8.953 ), Social function (54.92±7.037 vs 47.16±8.953 ) and Overallscore (51.22±10.967 vs 43.54±11.568) (all P<0.05).3. Result of correlation analysis: Depression, stigma and its subcomponentsignificantly correlated with lower QOLIE-31 in all domains scores (P<0.05), butperceived social support and its subcomponent positive correlated with QOLIE-31 inall domains scores (P<0.05).4. Multiple linear regression for QOLIE-31 overall scores showed that depression,stigma, perceived social support were significantly influencing factors for QOLIE-31overall, accounting for 61.0% of the variance.Conclusions1. Compared to active epileptic patients, seizure-free subjects have higher scoresin Seizure worry, General QOL, Cognitive function, Medication effects, Socialfunction and Overall score .2. Although QOL has multiple determinants, depression, stigma and perceivedsocial support are the most important factors affecting QOL in patients with epilepsy.Severe depression and stigma are associated with lower QOL in all domains, butmore perceived social support are positive associated with higher QOL in alldomains.