Quantifying the burden of generalized tonic-clonic seizures in patients with drug-resistant epilepsy.
Adult
Anticonvulsants
/ therapeutic use
Anxiety
/ psychology
Cost of Illness
Depression
/ psychology
Drug Resistant Epilepsy
/ drug therapy
Epilepsy
/ drug therapy
Female
Humans
Linear Models
Logistic Models
Male
Middle Aged
Multivariate Analysis
Patient Reported Outcome Measures
Quality of Life
Seizures
/ physiopathology
Severity of Illness Index
Young Adult
patient-reported outcomes
quality of life
resource utilization
seizure frequency
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
26
02
2020
revised:
11
06
2020
accepted:
12
06
2020
pubmed:
14
7
2020
medline:
23
1
2021
entrez:
14
7
2020
Statut:
ppublish
Résumé
Compared to other seizure types, generalized tonic-clonic (GTC) seizures may be disproportionately related to increased morbidity, and reducing seizure frequency could translate into improvements across measures of morbidity in medically treated patients with drug-resistant epilepsy (DRE). The primary objective of this analysis was to quantify the burden of patients with DRE who experience GTC seizures (GTC+) compared to patients with DRE who do not experience GTC seizures (GTC-). Adult patients from the Cleveland Clinic Epilepsy Center-Neurological Institute from 2012-2016 with DRE with epilepsy for at least 1 year were eligible for inclusion and were divided into GTC ± groups based on whether the patient had experienced a GTC seizure in the year preceding the first visit. Epilepsy duration, comorbidities, antiepileptic drug use, patient-reported outcomes (PROs) and seizure type, frequency, and etiology were captured. Generalized linear models, negative binomial regression, logistic regression, and linear regression were used as appropriate for multivariate analyses. A total of 379 patients met inclusion criteria and had data at 1-year follow-up after their baseline visit (192 GTC+ and 187 GTC-). Although DRE patients experiencing GTC seizures had fewer seizures per day over the preceding 6 months than those not experiencing GTC seizures, seizure severity and levels of depression and anxiety were greater. GTC+ patients who reported five or more seizures in the preceding 4 weeks had 82% lower odds (1-0.18 = 0.82) of working than patients with no seizures. Patients with DRE experience a significant burden and decreased quality of life. Multivariate analysis is necessary to understand the complex relationship between seizure type, frequency, and impact on health-related quality of life (HRQoL) and changes over time. Effective treatments to reduce the burden for DRE patients who experience GTC seizures continue to be needed.
Substances chimiques
Anticonvulsants
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1627-1637Subventions
Organisme : Eisai, Inc.
Pays : International
Informations de copyright
© 2020 International League Against Epilepsy.
Références
Moshé SL, Perucca E, Ryvlin P, Tomson T. Epilepsy: new advances. Lancet. 2015;385:884-98.
Brodie MJ. Pharmacological treatment of drug-resistant epilepsy in adults: a practical guide. Curr Neurol Neurosci Rep. 2016;16:82.
Dalic L, Cook MJ. Managing drug-resistant epilepsy: challenges and solutions. Neuropsychiatr Dis Treat. 2016;12:2605-16.
Kalilani L, Sun X, Pelgrims B, Noack-Rink M, Villanueva V. The epidemiology of drug-resistant epilepsy: a systematic review and meta-analysis. Epilepsia. 2018;59:2179-93.
Granata T, Marchi N, Carlton E, et al. Management of the patient with medically refractory epilepsy. Expert Rev Neurother. 2009;9:1791-802.
Silva B, Canas-Simião H, Cordeiro S, Velosa A, Oliveira-Maia AJ, Barahona-Corrêa JB. Determinants of quality of life in patients with drug-resistant focal epilepsy. Epilepsy Behav. 2019;100:106525.
Hansen B, Szaflarski M, Bebin EM, Szaflarski JP. Affiliate stigma and caregiver burden in intractable epilepsy. Epilepsy Behav. 2018;85:1-6.
Puri I, Dash D, Padma MV, Tripathi M. Quality of life and its determinants in adult drug refractory epilepsy patients who were not candidates for epilepsy surgery: a correlation study. J Epilepsy Res. 2018;8:81-6.
Sheikh S, Thompson N, Bingaman W, Gonzalez-Martinez J, Najm I, Jehi L. (Re)Defining success in epilepsy surgery: The importance of relative seizure reduction in patient-reported quality of life. Epilepsia. 2019;60:2078-85.
DeGiorgio CM, Markovic D, Mazumder R, Moseley BD. Ranking the leading risk factors for sudden unexpected death in epilepsy. Front Neurol. 2017;8:473.
Katzan I, Speck M, Dopler C, et al. The Knowledge Program: an innovative, comprehensive electronic data capture system and warehouse. AMIA Annu Symp proc AMIA Symp. 2011;2011:683-92.
Scott-Lennox J, Bryant-Comstock L, Lennox R, Baker G. Reliability, validity and responsiveness of a revised scoring system for the Liverpool Seizure Severity Scale. Epilepsy Res. 2001;44:53-63.
Cramer JA, Arrigo C, Van Hammée G, Bromfield EB. Comparison between the QOLIE-31 and derived QOLIE-10 in a clinical trial of levetiracetam. Epilepsy Res. 2000;41:29-38.
Cramer JA, Perrine K, Devinsky O, Meador K. A brief questionnaire to screen for quality of life in epilepsy: the QOLIE-10. Epilepsia. 1996;37:577-82.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-13.
Kroenke K, Spitzer RL, Williams JBW, Löwe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32:345-59.
Löwe B, Decker O, Müller S, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46:266-74.
Taylor RS, Sander JW, Taylor RJ, Baker GA. Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review. Epilepsia. 2011;52:2168-80.
Pompili M, Serafini G, Innamorati M, et al. Factors associated with hopelessness in epileptic patients. World J Psychiatry. 2014;4:141-9.
Ridsdale L, Wojewodka G, Robinson E, et al. Characteristics associated with quality of life among patients with drug-resitant epilepsy. J Neurol. 2017;264:1174-84.
Luoni C, Bisuilli F, Canevini MP, et al. Determinants of health-related quality of life in pharmacoresistant epilepsy: results from a large multicenter study of consecutively enrolled patients using validated quantitative assessments. Epilepsia. 2011;52:2181-91.
Gupta S, Kwan P, Faught E, Tsong W, Forsythe A, Ryvlin P. Understanding the burden of idiopathic generalized epilepsy in the United States, Europe, and Brazil: an analysis from the National Health and Wellness Survey. Epilepsy Behav. 2016;55:145-56.
Eadie MJ. Relationships within the idiopathic generalized epilepsies. J Clin Neurosci. 1997;4:201-8.
Winawer MR, Marini C, Grinton BE, et al. Familial clustering of seizure type wihin the idiopathic generalized epilepsies. Neurology. 2005;65:523-8.
Gross RA. The profusion of genotypes and phenotypes in “idiopathic” generalized epilepsies. Neurology. 2005;65:503.