VA Portland Health Care System, Portland, OR, United States of America; Oregon Health & Science University, Portland, OR, United States of America.
William S. Middleton Memorial Veterans Affairs Medical Center, Madison, WI, United States of America.
Epilepsy Behav. 2019 May;94:72-77. doi: 10.1016/j.yebeh.2019.02.010. Epub 2019 Mar 17.
Health-related quality of life (HRQoL) is compromised in civilians with epileptic seizures (ES) or psychogenic nonepileptic seizures (PNES). U.S. Veterans are a distinct patient group with regard to gender, age, and background. We studied HRQoL in Veterans and asked the following: (1) Is there a difference in HRQoL in Veterans with ES vs. PNES?; (2) What factors influence HRQoL in each group?; (3) What factors influenced the difference between seizure groups?
We studied consecutive Veterans entering the epilepsy monitoring units (EMUs) of three VA Epilepsy Centers of Excellence. Patients underwent continuous video-EEG monitoring. Seizure diagnoses followed established criteria. Health-related quality of life was measured with the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Evaluations included the Structured Clinical Interview for Diagnostic and Statistical Manual-IV (DSM IV), the posttraumatic stress disorder (PTSD) Checklist (PCL), the Beck Depression Inventory II (BDI-II), and the Minnesota Multiphasic Personality Inventory-2 Restructured form (MMPI-2RF). Between-group differences were tested with Wilcoxon tests. Nested regression analysis was used to evaluate the influence of demographic, social, military, seizure-related, and psychological factors on QOLIE-31 scores.
The median QOLIE-31 total score was 14 points lower in Veterans with PNES vs. ES (p < 0.001; Cohen's d = 0.73). Within each seizure group, psychological factors accounted for ≥50% of the variance in QOLIE scores while combined demographic, social, and seizure-related factors accounted for 18% (group with ES) and 7% (PNES). Psychological measures, particularly PCL and the BDI-II scores, accounted for all of the difference in QOLIE-31 total scores between Veterans with ES and those with PNES.
Health-related quality of life as measured by the QOLIE-31 is worse in Veterans with PNES as compared with those with ES. Psychological factors account for the most of the variance in QOLIE-31 scores regardless of seizure type and also account for the difference between groups with PNES and ES. Demographic, military, social, and seizure-related factors have minimal influence on HRQoL. These results in U.S. Veterans are similar to those found in civilians despite differences in patient age, gender, and background.
患有癫痫发作（ES）或心因性非癫痫发作（PNES）的平民的健康相关生活质量（HRQoL）受损。美国退伍军人在性别、年龄和背景方面是一个独特的患者群体。我们研究了退伍军人的 HRQoL，并提出了以下问题：（1）ES 和 PNES 退伍军人的 HRQoL 是否存在差异？（2）哪些因素影响每个组的 HRQoL？（3）哪些因素影响癫痫组之间的差异？
我们研究了进入三个退伍军人事务部癫痫卓越中心癫痫监测单位（EMU）的连续退伍军人。患者接受了连续视频-EEG 监测。根据既定标准诊断癫痫发作。采用生活质量在癫痫量表-31（QOLIE-31）测量健康相关生活质量。评估包括诊断和统计手册-IV（DSM-IV）的结构性临床访谈、创伤后应激障碍（PTSD）检查表（PCL）、贝克抑郁量表 II（BDI-II）和明尼苏达多相人格问卷-2 重构形式（MMPI-2RF）。采用 Wilcoxon 检验检验组间差异。嵌套回归分析用于评估人口统计学、社会、军事、与癫痫发作相关和心理因素对 QOLIE-31 评分的影响。
PNES 退伍军人的 QOLIE-31 总分中位数比 ES 退伍军人低 14 分（p<0.001；Cohen's d=0.73）。在每个癫痫发作组中，心理因素占 QOLIE 评分变异的 50%以上，而人口统计学、社会和与癫痫发作相关的综合因素分别占 18%（ES 组）和 7%（PNES）。心理测量，特别是 PCL 和 BDI-II 评分，占 ES 和 PNES 退伍军人 QOLIE-31 总分差异的全部。
与 ES 退伍军人相比，PNES 退伍军人的 QOLIE-31 测量的健康相关生活质量更差。心理因素无论癫痫发作类型如何，都占 QOLIE-31 评分变异的最大部分，也占 PNES 和 ES 组之间差异的原因。人口统计学、军事、社会和与癫痫发作相关的因素对 HRQoL 的影响很小。尽管患者年龄、性别和背景存在差异，但美国退伍军人的这些结果与平民相似。
