SALT LAKE CITY – For veterans with epilepsy, quality of life is most negatively impacted by frequency of seizures, according to a new study. And that, plus some other factors, usually means that younger veterans have a tougher time with epilepsy than older ones.
A report in the journal Epilepsy & Behavior pointed out that the neurological disorder has wide-ranging effect on patient lives, noting, “Although previous work has investigated epilepsy impact on health status, little is known about the overall quantified impact of epilepsy in veterans.”1
Researchers from the VA Salt Lake City Healthcare System and the University of Utah School of Medicine, both in Salt Lake City, explained that their goal was to describe the impact of epilepsy on Veterans’ lives using the Personal Impact of Epilepsy Scale (PIES). They also sought to determine the patient and clinical characteristics most strongly correlated with epilepsy impact.
The study also described cohort characteristics and developed regression models to determine which characteristics were most strongly associated with PIES subscale (seizure, medication, comorbidity) scores and quality of life (QOL).
A survey had a response rate of 36%; of the 438 respondents included in the analyses, about half were aged 45-64 years (35% >65; 14% 18-44 and; 19% were women. Among respondents, nearly 90% had previously received care by an epilepsy specialist, 37% of which was at VHA facilities and another 38% in both VHA and community care.
Results demonstrated that PIES scores were moderately low (mean: 88.68, [standard deviation (SD) = 63.24]; 300 total). Researchers pointed out that PIES overall and subscale scores were significantly lower for older veterans with epilepsy (VWE) (>65) compared with younger (18-44 years) and middle-aged (45-64 years) VWE [p < 0.001]. That suggested that older veterans had a lower epilepsy impact overall, and for seizures, medication, and comorbidity, the authors explained.
In addition, younger and middle-aged veterans with epilepsy had a significantly higher rate of psychiatric diagnosis compared with older veteran patients [p < 0.001].
The study also noted a trend for significance for the overall PIES scores by gender, with women having total higher (worse) scores (mean = 93.10, SD = 69.68) than men (mean = 74.39, SD = 59.97). That was driven by a statistically higher score on the seizure subscale for women (mean = 27.66, SD = 27.97) compared with men (mean = 19.29, SD 25.35; p = 0.04), according to researchers.
In fact, they said, regression models revealed that frequent seizures (>1/month, >2/month) and diagnoses of dementia significantly predicted higher (more negative) Seizure Severity PIES score [all p < 0.05]. Negative impact was predicted by frequent seizures (>1/month), number of antiepileptic drugs (AEDs), and diagnosis of dementia, while older age predicted positive impact for medication subscale. Frequent seizures (>1/month) and diagnoses of depression and dementia also predicted negative mood and social impact [all p < 0.05].
Still, the authors advised, seizure frequency of two or more times a month was the only variable that significantly predicted lack of excellent quality of life and that gender did not appear to be significant after controlling for other variables.
“Findings were similar to a prior study of generic health outcomes in younger and older VWE [veterans with epilepsy] using the 36-Item Short Form Survey (SF-36),” researchers concluded. “Seizure frequency was consistently associated with negative impact of epilepsy in all age groups.”
They noted that, while dementia and other diagnosed health conditions also contributed to epilepsy impact, older veterans with epilepsy had significantly lower PIES scores even after controlling for physical conditions and dementia, positing, “Lower (better) scores for comorbidity and medication scales in older VWE may be due to fewer diagnosed psychiatric comorbidities and psychiatric medication that have similar cognitive impact as AEDs, and which may also interact with AEDs.”
The authors suggested that implementation of patient self-management programs to improve seizure control might “reduce epilepsy impact for veterans and reduce Veterans Affairs (VA) healthcare utilization. The PIES may also be useful to measure outcomes of self-management interventions.”
- Reyes-Miranda A, Chan S, Gowda S, Kean J, Cramer JA, Pugh MJ. Assessing the personal impact of epilepsy in a population-based cohort of Veterans. Epilepsy Behav. 2020 May;106:107047. doi: 10.1016/j.yebeh.2020.107047. Epub 2020 Apr 1. PMID: 32247175.