title: Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy.
abstract: BACKGROUND
  The two-thirds of patients with epilepsy who become seizure-free have a quality of life (QOL) similar to the general population. The major treatment challenge is patients with refractory epilepsy. Whereas neurologists typically focus on seizure reduction in the treatment of these patients, results of studies relating seizure frequency to QOL are conflicting. As depression is associated with reduced QOL in epilepsy and antiepileptic medications (AEDs) can cause depression, it is important to determine the relative roles of depression and seizure frequency in QOL in refractory epilepsy.
  
  
  METHODS
  Prospective evaluation was conducted of patients with refractory epilepsy being admitted to an inpatient video-EEG monitoring unit. The impact of clinical variables (age, sex, marital status, seizure frequency, duration and type of seizure disorder, seizure localization, number of AEDs, depression) on QOL was analyzed.
  
  
  RESULTS
  Depression was a powerful predictor of QOL (n = 122, beta = -35.8, p < 0.0001). No other variable predicted QOL. Depression was common (54%), severe (19% with suicidal thoughts), underdiagnosed (37%), and largely untreated (17% on antidepressants).
  
  
  CONCLUSIONS
  Treatment of depression may be inadequately prioritized in the management of intractable epilepsy.
authors.affiliation: New York University School of Medicine, New York, NY 10016, USA. laura.boylan@med.nyu.edu
authors.forename: L S
authors.initials: LS
authors.lastname: Boylan
authors.forename: L A
authors.initials: LA
authors.lastname: Flint
authors.forename: D L
authors.initials: DL
authors.lastname: Labovitz
authors.forename: S C
authors.initials: SC
authors.lastname: Jackson
authors.forename: K
authors.initials: K
authors.lastname: Starner
authors.forename: O
authors.initials: O
authors.lastname: Devinsky
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D015331:Cohort Studies; D003863:Depression / Q000139:chemically induced / Q000150:complications*; D004351:Drug Resistance; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors
chemical_list: D000927:Anticonvulsants