title: Epilepsy in patients with primary brain tumors: The impact on mood, cognition, and HRQOL.
abstract: BACKGROUND
  A primary brain tumor (PBT) is often a fatal disease of the nervous system and has a serious impact on health-related quality of life (HRQOL). Presence of epilepsy and adverse reactions from tumor and epilepsy treatments may cause additional decline in HRQOL.
  
  
  OBJECTIVE
  We aimed to study the impact of epileptic seizures on cognition, mood, and HRQOL in patients with brain tumor-related epilepsy.
  
  
  METHODS
  Patients were grouped on an ordinal scale according to epilepsy burden from none to severe based on the presence of epileptic seizures and seizure frequency: L1, no epilepsy; L2, with epilepsy, seizure-free in the last 6 months with antiepileptic drugs; and L3, with epilepsy, at least one seizure in the last 6 months with AEDs. Health-related quality of life was measured by Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Quality of Life in Epilepsy-31 (QOLIE-31) tools, cognition by the Montreal Cognitive Assessment (MoCA) tool and Frontal Assessment Battery (FAB), mood by the Hospital Anxiety and Depression Scale (HADS), activities of daily living (ADLs) by the Barthel Index (BI), and performance status by the Karnofsky Performance Status (KPS) scale in patients with primary brain tumors at least one month following neurosurgery with or without radiotherapy and chemotherapy.
  
  
  RESULTS
  Eighty-one patients with a diagnosis of primary brain tumors were recruited. Sixty-eight percent of patients were diagnosed with primary brain tumor-related epilepsy, 50.61% patients had cognitive impairment, 33% had abnormal scores in the anxiety scale, and 34% had abnormal scores in the depression scale. There were no statistically significant differences in these scores among L1, L2, and L3 groups. There were statistically significant differences in duration of disease and KPS and BI scores between L1 and L3 groups. The L3 group has significantly longer duration of disease and scored low in both the BI and KPS scale when compared to the L1 group. All patients with primary brain tumors scored significantly low in FACT-Br 'physical well-being' (PWB) and 'emotional well-being' (EWB) and high in 'social well-being' (SWB) when compared to healthy controls. When scores of each group were individually compared to healthy controls, the L3 group showed the lowest scores in PWB, EWB, and 'functional well-being'. In SWB, L1 and L2 groups showed statistically significantly high scores when compared to normative data. The QOLIE-31 applied to groups with epilepsy showed statistically significantly lower scores in the L3 group when compared to the L2 group in 'cognitive' and 'social functioning' domains. On multivariate analysis, both poor performance status and frequency of seizures were found to be independent risk factors for poor HRQOL when FACT-Br mean scores were compared. Level of seizures was found to be an independent risk factor for poor HRQOL when QOLIE-31 scores were compared between L2 and L3 groups.
  
  
  CONCLUSIONS
  Presence of brain tumors could be attributed to cognitive impairment irrespective of the presence of epilepsy in our cohort. High seizure burden is an independent risk factor for poor HRQOL in patients with primary brain tumors. The QOLIE-31 is a more sensitive tool than the FACT-Br because of the presence of a seizure-related questionnaire.
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW 2145, Australia. Electronic address: zebun97@hotmail.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Rahman
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Hawkesbury Road, Westmead 2145, Australia.
authors.forename: C H
authors.initials: CH
authors.lastname: Wong
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Hawkesbury Road, Westmead 2145, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Dexter
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Hawkesbury Road, Westmead 2145, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Olsson
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW 2145, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Wong
authors.affiliation: The University of Sydney, NSW 2006, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Gebsky
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW 2145, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Nahar
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW 2145, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Wood
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW 2145, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Byth
authors.affiliation: The University of Sydney, NSW 2006, Australia.
authors.forename: M
authors.initials: M
authors.lastname: King
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW 2145, Australia.
authors.forename: A B
authors.initials: AB
authors.lastname: Bleasel
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D001932:Brain Neoplasms / Q000150:complications* / Q000523:psychology / Q000601:surgery; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D004827:Epilepsy / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012640:Seizures / Q000188:drug therapy / Q000523:psychology; D012720:Severity of Illness Index; D012917:Social Adjustment; D011795:Surveys and Questionnaires
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic; Brain tumor-related epilepsy; Chemotherapy; Cognition; Health-related quality of life; Radiotherapy