Seizure frequency and the health-related quality of life of adults with epilepsy

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Abstract
Objective: To compare the health-related quality of life (HRQL) of a nonsurgical sample of adults with epilepsy with that of age- and gender-equivalent norms, and to analyze the relative importance of seizure frequency, time since last seizure, gender, and comorbidity on HRQL in the epilepsy sample. Methods: Data were obtained from 139 adults with epilepsy from three US centers and published norms on the Medical Outcomes Study Short-Form 36 (SF-36). Patients were classified according to number of seizures over the prior 4 weeks (zero, one to five, six or more). Bivariate and multivariate modeling was used. Results: HRQL scores for seizure-free patients were similar to the general population. Significant differences between seizure frequency groups were found for seven domains and the physical and mental component summary scales of the SF-36 (p < 0.001). No differences were found in bodily pain. The largest differences were in physical role and social functioning, and general health (p < 0.001). In the multivariate model, seizure frequency was a significant inverse predictor of HRQL across all domains (p < 0.01 to 0.001). Men reported poorer physical function than women (p < 0.05), and patients with a comorbid condition had poorer HRQL in the areas of pain (p < 0.05) and general health perception (p < 0.01). Time since last seizure was not related uniquely to HRQL. Conclusions: Seizure-free adults can have HRQL levels comparable with those of the general population. As seizure frequency increases, patients report more impaired HRQL, regardless of time since last seizure, gender, and comorbid status. Potential for difficulties in HRQL should be considered in clinical assessment and in evaluating treatment outcomes.