Discussion
The purpose of our study was to identify factors influencing quality of life in epilepsy patients. According to the results, the study shows that factors associated with quality of life in adult epilepsy patients were psychiatric problems and AEDs. Absence of psychiatric problems and patients on single AED were associated with good quality of life and Psychiatric diagnosis (depression and anxiety) and multiple AEDs were strong predictors of poor quality of life. Previous work revealed that the most important determinants for patients with epilepsy were social and psychological aspects, effects of antiepileptic drugs and seizure frequency, which were determinants of poor QOL, scores (Suurmeijer, et al., 2001). This study shows no difference on the above mentioned factors on the score of QOL, though there was variation in seizure frequency. Another study by Yue L et al., (2011) indicated anxiety and seizure related variables as the strongest predictors of QOLIE among men.
In the present study depression and anxiety were prominent predictors for poor quality of life in epilepsy patients. Previous studies have also reported high prevalence of psychological and social disorders reported in-patients with epilepsy (Kogeorgos, et al., 1982). In a study by Lehrner et al., (1999) found depression was the single strongest predictor for each field of health —related quality of life in patients with temporal lobe epilepsy. There was a significant association with health related quality of life and depression which continued to exist even after controlling seizure frequency, seizure severity, and other psychosocial variables. Anxiety is a common consequence of the unpredictable nature of some epilepsies. (Guekht et al., 2007). People with epilepsy have been reported to be more prone to depression than those without epilepsy (Robertson et al., 1987). These studies support our finding that depression and anxiety were major determining factors for poor quality of life.
Herodes et al., (2001) indicated demographic variables such as age, sex and education as well as socio- economic status (SES) in determining the quality of life which was not significant. Leidy et al., (1993) reported that QOL differs across epilepsy patients with different clinical, demographic and socio economic variables. This is similar to our study single AED therapy showed good quality of life. With regard to clinical variables, multiple AED use was found to be a significant predictor of the quality of life poor scores, similar to the study by Suurmeijer et al., (2001). Seizure type was not a significant factor in the present study similar to other studies (Baker et al., 1997-98). The findings of our study are comparable to some studies where age, sex and education did not correlate significantly with the quality of life (Suurmeijer et al., 2001 & Baker et al., 2001).
Previous studies have highlighted the employment difficulties faced by persons with epilepsy i.e. underemployment and unemployment has been identified as two of the most serious problems, they face also lower rates of marriages (Floyd, 1986 & Rodin et al., 1972). The study by Djibuti and Shakarishvili (2003) revealed education as one of the strongest predictor of low quality of life. Unlike these studies according to our study most of the patients were either studying or employed in some profession though most of females happen to be housewives.
In conclusion, these findings show that psychiatric problems may be a potential challenge for people with epilepsy to cause poor QOL. Improving the patient’s quality of life (QOL) is one of the most important goals of epilepsy management and it may be necessary to individualize interventions such as counseling and psychotherapy techniques to improve the QOL in epilepsy patients. The major advantage of the study is large number of epilepsy patients but limitation is a cross- sectional study without control or follow-up. Our data also suggest multiple AED as powerful predictor of poor quality of life. The factor associated with QOL emphasizes the importance of effective treatment and alleviating anxiety and depression levels, which may improve the quality of life.
Abbreviations: International Classification of Disorders- (ICD-10), Liverpool seizure severity scale (LSSS) and Quality of life in epilepsy (QOLIE-31 & 89), Antiepileptic drugs (AED) & Analysis of variance (ANOVA’s).
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