Abstracts

Rationale: Measuring the quality of life (QOL) of people with epilepsy (PWE) is recognized as an important component of clinical management. However, there is a relative paucity of quality of life (QOL) research in resource-limited settings among people with epilepsy (PWE). We aimed to assess the influence of clinical and demographic variables on QOL in PWE in the lower middle-income country of Bhutan.Methods: Bhutanese patients, ages 12 years and older, were interviewed as part of an ongoing epilepsy cohort study, based at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu (July 2014 – April 2015). The 31-question version of the QOL-in-epilepsy (QOLIE) questionnaire was administered to 223 participants and clinical and demographic data were collected via self-reported questionnaires. A wealth index was constructed based on self-reported assets data. Multiple linear regression models were constructed to test for an association between quality of life in epilepsy and its potential clinical and demographic predictors.Results: The mean QOL score was low 48.6/100 points (SD 13.8) in the cohort (mean age 32 years (SD 9.8); female 54%). Higher age and educational level were positively associated with QOLIE (p=0.024 and p=0.035, respectively) but gender, loss of consciousnesss, and taking more than two antiepileptic medications did not show statistically significant associations with QOL (p>0.05 for each). Although wealth positively associated with QOL score at a statistically significant level, when education was included in the model, this effect became non-significant.Conclusions: Quality of life in epilepsy is overall low in Bhutan, a country with free access to several antiepileptic medications. In particular, younger people and those with lower education levels represent segments of the Bhutanese population with lower QOL. The positive impact of wealth on QOL became non-significant when educational level was taken into account, suggesting that higher levels of education rather than material wealth can improve the quality of life among people with epilepsy in lower income settings. Focusing on younger patients and those with the least access to formal education may be most helpful in improving the burden of epilepsy among people in Bhutan and perhaps other developing countries with similar income levels.