Determinants of health-related quality of life in pharmacoresistant epilepsy: Results from a large multicenter study of consecutively enrolled patients using validated quantitative assessments
Determinants of health-related quality of life in pharmacoresistant epilepsy: Results from a large multicenter study of consecutively enrolled patients using validated quantitative assessments
复制标题
DOI：
10.1111/j.1528-1167.2011.03325.x
复制
发表时间：
2011-12-01
期刊：
影响因子：
5.6
通讯作者：
Perucca, Emilio
中科院分区：
文献类型：
--
作者：
Luoni, Chiara;Bisulli, Francesca;Perucca, Emilio
目的：评估人口统计学和癫痫相关变量、抑郁症状和抗癫痫药物（AED）的不良反应（AE）对耐药癫痫成年人健康相关生活质量（HRQOL）的相对贡献。方法：癫痫发作未能缓解的癫痫患者至少一种AED连续入组11个三级转诊中心。通过癫痫生活质量量表-31（QOLIE 31）评估HRQOL，通过不良事件特征（AEP）评估AE，通过贝克抑郁量表II（BDI-II）评估抑郁症状。多元线性回归模型被用来确定变量与QOLIE-31总分和子量表scores.Key结果：933名年龄在16岁或以上的登记人员，809（87%）能够完成自我评估工具，并被列入分析。总体而言，最终模型解释了QOLIE-31评分中61%的方差。HRQOL的最强预测因子是AEP总分（β =-0.451，p < 0.001）和BDI-II评分（β =-0.398，p < 0.001）。这些因素也是7个QOLIE-31分量表中每个分量表得分的最强预测因子。HRQOL的其他预测因素包括年龄（β =-0.060，p = 0.008）、无驾驶执照（β =-0.053，p = 0.018）、耐药性等级，仅一种AED治疗失败的个体HRQOL较高（B = 0.066，p = 0.004）和招募中心的位置。癫痫相关变量（癫痫发作频率、强直阵挛发作发生率、癫痫发作年龄、病程）和AED数量对HRQOL无显著预测价值。AEP总评分是最强的负性预测HRQOL在362例患者的亚组无抑郁症状（BDI-II评分< 10），但即使在这个亚组的BDI-II评分被保留作为一个显着predictor.Significance：在个体与耐药性癫痫，药物和抑郁症状的AE是更重要的决定因素HRQOL比癫痫发作本身。当癫痫发作自由不能实现时，解决抑郁合并症和减少AED毒性负担可能比旨在减少癫痫发作频率的干预措施更有益。
Purpose: To evaluate the relative contribution of demographic and epilepsy-related variables, depressive symptoms, and adverse effects (AEs) of antiepileptic drugs (AEDs) to health-related quality of life (HRQOL) in adults with pharmacoresistant epilepsy.Methods: Individuals with epilepsy whose seizures failed to respond to at least one AED were enrolled consecutively at 11 tertiary referral centers. HRQOL was assessed by the Quality of Life in Epilepsy Inventory-31 (QOLIE31), AEs by the Adverse Event Profile (AEP), and depressive symptoms by the Beck Depression InventoryII (BDI-II). Multivariate linear regression models were used to identify variables associated with QOLIE-31 total score and subscale scores.Key Findings: Of 933 enrolled individuals aged 16 years or older, 809 (87%) were able to complete the selfassessment instruments and were included in the analysis. Overall, 61% of the variance in QOLIE-31 scores was explained by the final model. The strongest predictors of HRQOL were AEP total scores (beta = -0.451, p < 0.001) and BDI-II scores (beta = -0.398, p < 0.001). These factors were also the strongest predictors of scores in each of the seven QOLIE-31 subscales. Other predictors of HRQOL were age (beta = -0.060, p = 0.008), lack of a driving license (beta = -0.053, p = 0.018), pharmacoresistance grade, with higher HRQOL in individuals who had failed only one AED (b = 0.066, p = 0.004), and location of the enrolling center. Epilepsy-related variables (seizure frequency, occurrence of tonic-clonic seizures, age of epilepsy onset, disease duration) and number of AEDs had no significant predictive value on HRQOL. The AEP total score was the strongest negative predictor of HRQOL in the subgroup of 362 patients without depressive symptoms (BDI-II score < 10), but even in this subgroup the BDI-II score was retained as a significant predictor.Significance: In individuals with pharmacoresistant epilepsy, AEs of medication and depressive symptoms are far more important determinants of HRQOL than seizures themselves. When seizure freedom cannot be achieved, addressing depressive comorbidity and reducing the burden of AED toxicity is likely to be far more beneficial than interventions aimed at reducing the frequency of seizures.