Determinants of disease severity in adults with epilepsy: Results from the Neurological Diseases and Depression Study.
BACKGROUND
Epilepsy severity has been recognized as a significant predictor of health-related quality of life in patients with epilepsy. However, clinical markers of epilepsy severity such as seizure frequency often fail to capture important aspects of the disease. This study investigates the factors associated with patient-reported severity of epilepsy, assessed by the Global Assessment of Severity of Epilepsy (GASE) scale in adults with epilepsy.


METHODS
Data from a cohort of 250 patients consecutively enrolled in the Neurological Diseases and Depression Study (NEEDS) were used to assess the determinants of epilepsy severity as measured by the GASE scale. Multiple linear regression analyses were used to examine the mediation effect of clinical and sociodemographic characteristics on patients' ratings on the GASE scale.


RESULTS
The mean age of the study participants was 39.8 (SD=14.9) years, of which 44.4% were male. About 66.8% of the participants reported "not at all severe" or "a little severe" epilepsy, while 0.4% reported "extremely severe" epilepsy. One-year seizure freedom, number of antiseizure medications, medication side effects, depression, anxiety, and seizure-related disability were identified as significant determinants of patients' ratings of epilepsy severity. Seizure-related disability mediated the effects of 1-year seizure freedom, number of antiseizure medications, and medication side effects on epilepsy severity.


CONCLUSIONS
Overall, patients with epilepsy who reported higher GASE scores were less likely to achieve 1-year seizure freedom and more likely to be on more antiseizure medications, experience more side effects from medication, endorse more depression and anxiety symptoms, and have increased self-reported seizure-related disability. The identified determinants of global, self-rated epilepsy severity can aid the design of appropriate interventions and support services for patients with severe epilepsy.
Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Clinical Research Unit, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada. Electronic address: tolu.sajobi@ucalgary.ca.
Tolulope T
TT
Sajobi
Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
Nathalie
N
Jette
Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Yukun
Y
Zhang
Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Department of Psychiatry, University of Calgary, Calgary, Canada.
Scott B
SB
Patten
Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
Kirsten M
KM
Fiest
Clinical Research Unit, University of Calgary, Calgary, Canada.
Jordan D T
JD
Engbers
Clinical Research Unit, University of Calgary, Calgary, Canada.
Mark W
MW
Lowerison
Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Clinical Research Unit, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
Samuel
S
Wiebe
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
Depression and anxiety; Epilepsy severity; Global Assessment of Severity of Epilepsy; Patient-reported outcomes; Seizure-related disability