Epilepsy treatment as a predeterminant of psychosocial ill health.
Epilepsy is a chronic disorder with complex effects on social, vocational, physical, and psychological well-being. Patient-oriented research has demonstrated that recurrent seizures have a strong adverse effect on health-related quality of life, but also that seizure rate in persons with pharmacoresistant epilepsy has only a modest correlation with quality of life. Although treatment side effects have received limited attention in epilepsy research, available evidence indicates that adverse medication effects may explain more variance in quality of life than any other clinical variable in persons with pharmacoresistant epilepsy. Furthermore, systematic screening for adverse effects has been shown to be associated with significant reduction in subjective toxicity and improvement in quality of life. There has been only limited research on the relative contribution of specific adverse effects to impaired health-related quality of life. The relative importance of reduction of medication burden after resective epilepsy surgery or vagal nerve stimulation has similarly received sparse attention. Existing deficiencies in the available published research present challenges and opportunities to perform further investigations to define and improve best clinical practices in epilepsy care.
Perucca
Piero
P
Department of Neurology, Columbia University, New York, NY 10032, USA.
Gilliam
Frank G
FG
Schmitz
Bettina
B
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D004827:Epilepsy / Q000523:psychology* / Q000628:therapy*; D006304:Health Status; D006801:Humans; D009493:Neurosurgery / Q000379:methods*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012917:Social Adjustment; D055536:Vagus Nerve Stimulation / Q000379:methods
D000927:Anticonvulsants