Abstracts

Rationale: Epilepsy can negatively affect quality of life (QOL) and increase risk of psychosocial problems. Although seizure frequency is an important determinant of QOL, other social and psychological factors have also been implicated. Co-morbidities such as depression, anxiety and sleep problems are increasingly under investigation. All these factors are known to be predictive of impaired QOL and common among people with epilepsy (PWE). In this study, we examine prevalence of anxiety and sleep disorders in PWE, and their relative contributions to overall quality of life. Methods: Questionnaires were mailed to two UK samples: a tertiary clinic population (n = 550) and members of the patient organisation, Epilepsy Action (EA; n = 1000). Additionally, EA members could complete questionnaires on-line. Questionnaires were also distributed to an opportunity sample of controls without epilepsy. Questionnaires contained previously validated scales to assess levels of anxiety, sleep disorder, adverse drug effects, felt stigma, levels of social support and clinical and socio-demographic features. Questionnaires were returned by 196 clinic patients, 751 EA members and 297 controls. Data were analysed using regression techniques. Overall QOL was assessed using Andrews & Withey s terrible-delighted faces scale (7-point scale, best-worst QOL); anxiety by the Speilberger State-Trait Anxiety Inventory (40 items, 20 state , 20 trait ); sleep problems by the Pittsburgh Sleep Quality Index (19 items, subjects scoring >5 classified as poor sleepers); and the Epworth Daytime Sleepiness Scale (8 items, subjects classified as normal or needing special advice ). Results: The epilepsy samples differed in terms of their clinical status, the clinic sample being more likely to have experienced multiple seizures in the previous year (p<0.001), a higher average number of seizures per month (p<0.001), earlier age of seizure onset (p=0.024), polytherapy (p<0.001), and other long-term co-morbidities (p<0.001). Only 50% of PWE assessed overall QOL as positive, compared with 75% of controls; a third described it as negative, compared with 14% (p<0.001). In a univariate analysis, factors predictive of overall QOL were: general health, health compared to 1 year ago, seizure worry, long-term health problems other than epilepsy, other (non-antiepileptic) medications, state and trait anxiety, social support, stigma and sleep problems. No clinical factor other than patient-perceived seizure control was important; nor were any socio-demographic factors other than marital status. The only factors remaining significant in a multivariate analysis were general health, trait anxiety, night-time sleep quality and social support. Conclusions: Clinical epilepsy factors contributed little to QOL, whereas wider health and social factors were important contributors. Our data suggest that with appropriate inputs, people with epilepsy can maintain a good QOL in spite of clinical adversity. This study was funded through an Investigator-Initiated Research Grant from Pfizer Ltd and sponsored by the University of Liverpool.