title: Quality of life in epilepsy in Bhutan.
abstract: To assess the quality of life in epilepsy (QOLIE) among adults in the lower middle-income country of Bhutan and assess the potential demographic and clinical associations with better QOLIE.
  
  
  
  People with clinically diagnosed epilepsy were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu (2014-2015). Regression models were constructed to assess the potential impact of age, sex, residence in the capital city, wealth quintile, educational attainment, seizure in the prior year, seizures with loss of consciousness, self-reported stigma score, and need for multiple antiepileptic drugs.
  
  
  
  The mean Bhutanese 48.4/100 ± 17.3 [corrected] score among 172 adults (mean age 31.1 years, 93 female) was 48.9/100±17.7. Younger age, lower educational attainment level, and increased self-perceived stigma were each observed to have an independent, negative association with QOLIE (p<0.05), while a patient's wealth quintile, sex, seizure frequency, seizure type and number of antiepileptic drugs were not. Education appeared to be most strongly associated with QOL at the high school and college levels.
  
  
  
  There are potentially modifiable associations with low QOLIE. Addressing the educational level and self-perceived stigma of PWE may have an especial impact. The low QOLIE in Bhutan may reflect cultural approaches to epilepsy, health services, or other factors including those outside of the health sector.
authors.affiliation: Partners Neurology Residency, Massachusetts General Hospital and Brigham and Woman's Hospital, Boston, USA. Electronic address: asaadi@partners.org.
authors.forename: Altaf
authors.initials: A
authors.lastname: Saadi
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, USA. Electronic address: bryanpatenaude@gmail.com.
authors.forename: Bryan
authors.initials: B
authors.lastname: Patenaude
authors.affiliation: Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan. Electronic address: drnirola@yahoo.com.
authors.forename: Damber Kumar
authors.initials: DK
authors.lastname: Nirola
authors.affiliation: Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan. Electronic address: somkey90@gmail.com.
authors.forename: Sonam
authors.initials: S
authors.lastname: Deki
authors.affiliation: Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan. Electronic address: tsheringlhab999@gmail.com.
authors.forename: Lhab
authors.initials: L
authors.lastname: Tshering
authors.affiliation: Massachusetts General Hospital, Boston, USA. Electronic address: sclark0929@gmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Clark
authors.affiliation: Massachusetts General Hospital, Boston, USA. Electronic address: lrshaull@gmail.com.
authors.forename: Lance
authors.initials: L
authors.lastname: Shaull
authors.affiliation: Massachusetts General Hospital, Boston, USA. Electronic address: tsorets@bbns.org.
authors.forename: Tali
authors.initials: T
authors.lastname: Sorets
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, USA. Electronic address: gfink@hsph.harvard.edu.
authors.forename: Guenther
authors.initials: G
authors.lastname: Fink
authors.affiliation: Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA. Electronic address: fmateen@mgh.harvard.edu.
authors.forename: Farrah
authors.initials: F
authors.lastname: Mateen
mesh_terms: D000328:Adult; D000368:Aged; D001631:Bhutan; D004827:Epilepsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D057545:Social Stigma; D055815:Young Adult
keywords: Asia; Education; Epilepsy; Global health; Quality of life