Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
The University of Texas Health Science at San Antonio, San Antonio, TX, USA.
Epilepsy Behav. 2020 May;106:107047. doi: 10.1016/j.yebeh.2020.107047. Epub 2020 Apr 1.
Epilepsy impacts patient lives in multidimensional ways. Although previous work has investigated epilepsy impact on health status, little is known about the overall quantified impact of epilepsy in Veterans. Our goal was to describe the impact of epilepsy on Veterans' lives using the Personal Impact of Epilepsy Scale (PIES) and determine the patient and clinical characteristics most strongly correlated with epilepsy impact. We 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).
Approximately 36% of those who were invited responded to the survey. Of the 438 respondents included in the analyses, roughly 50% were aged 45-64 years (35% >65; 14% 18-44); 19% were women. Almost 90% had previously received care by an epilepsy specialist, 37% of which was in Veterans Health Administration (VHA) and 38% in both VHA and community. The PIES scores were moderately low (mean: 88.68, [standard deviation (SD) = 63.24]; 300 total). The 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], indicating that older Veterans had a lower epilepsy impact overall, and for seizures, medication, and comorbidity. The younger and middle-aged VWE had a significantly higher proportion with psychiatric diagnosis compared with older VWE [p < 0.001]. There was 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), which 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). 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]. Frequent seizures (>1/month), number of antiepileptic drugs (AEDs), and diagnosis of dementia predicted negative impact, and older age predicted positive impact for medication subscale. Frequent seizures (>1/month) and diagnoses of depression and dementia predicted negative mood and social impact [all p < 0.05]. Seizure frequency (>2/month) was the only variable that significantly predicted lack of excellent QOL [p < 0.05]. Effects for gender were not significant after controlling for other variables.
Findings were similar to a prior study of generic health outcomes in younger and older VWE using the 36-Item Short Form Survey (SF-36). Seizure frequency was consistently associated with negative impact of epilepsy in all age groups. While dementia and other diagnosed health conditions also contributed to epilepsy impact, older VWE had significantly lower PIES scores even after controlling for physical conditions and dementia. 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. Implementation of patient self-management programs to improve seizure control may 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.
癫痫以多种方式影响患者的生活。尽管之前的工作已经研究了癫痫对健康状况的影响，但对于癫痫对退伍军人的整体量化影响知之甚少。我们的目标是使用个人癫痫影响量表（PIES）描述癫痫对退伍军人生活的影响，并确定与癫痫影响最密切相关的患者和临床特征。我们描述了队列特征，并建立了回归模型，以确定哪些特征与 PIES 子量表（发作、药物、合并症）评分和生活质量（QOL）最密切相关。
大约 36%的受邀者对调查做出了回应。在 438 名被纳入分析的受访者中，大约 50%的年龄在 45-64 岁（35%>65 岁；14%18-44 岁）；19%是女性。近 90%的人曾接受过癫痫专家的治疗，其中 37%在退伍军人事务部（VHA），38%在 VHA 和社区。PIES 评分中等偏低（平均：88.68，[标准差（SD）=63.24]；总分为 300）。与年轻（18-44 岁）和中年（45-64 岁）退伍军人相比，年龄较大的（>65 岁）癫痫退伍军人的 PIES 总分和子量表评分明显较低（p<0.001），这表明年龄较大的退伍军人整体癫痫影响较低，发作、药物和合并症也是如此。年轻和中年退伍军人的精神科诊断比例明显高于年长退伍军人（p<0.001）。PIES 总分的性别差异有显著趋势，女性的总评分（均值=93.10，SD=69.68）高于男性（均值=74.39，SD=59.97），这是由于女性在发作子量表上的评分（均值=27.66，SD=27.97）明显高于男性（均值=19.29，SD 25.35；p=0.04）。回归模型显示，频繁发作（>1/月，>2/月）和痴呆诊断显著预测更高（更负面）的发作严重程度 PIES 评分（均 p<0.05）。频繁发作（>1/月）、抗癫痫药物（AED）的数量和痴呆诊断预测药物子量表的负面影响，而年龄较大预测药物子量表的积极影响。频繁发作（>1/月）和抑郁、痴呆的诊断预测负面情绪和社会影响（均 p<0.05）。发作频率（>2/月）是唯一显著预测 QOL 不佳的变量（p<0.05）。控制其他变量后，性别效应不显著。
研究结果与使用 36 项简明健康状况调查（SF-36）对年轻和年长退伍军人进行的一般健康结果的先前研究相似。发作频率与所有年龄组的癫痫影响均呈负相关。虽然痴呆和其他诊断的健康状况也会导致癫痫影响，但即使在控制身体状况和痴呆后，年龄较大的退伍军人的 PIES 评分仍明显较低。年龄较大的退伍军人在合并症和药物量表上的评分较低（更好）可能是由于诊断出的精神科合并症和具有相似认知影响的精神科药物较少，且这些药物可能与 AED 相互作用。实施患者自我管理计划以改善发作控制可能会减少退伍军人的癫痫影响，并减少退伍军人事务部（VA）的医疗保健利用。PIES 也可用于衡量自我管理干预的结果。
