Lozano-García Alejandro, González-Bono Esperanza, Cano-López Irene
Faculty of Health Sciences, Valencian International University, Valencia, Spain; Department of Psychology, Universidad Europea de Valencia, Valencia, Spain.
Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de La Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain.
Epilepsy Behav. 2025 Jan;162:110170. doi: 10.1016/j.yebeh.2024.110170. Epub 2024 Nov 29.
Drug-resistant epilepsy usually requires the use of polytherapy with antiseizure medications (ASMs) for management, which could involve side and adverse effects that may impact quality of life (QOL). This systematic review summarizes the evidence about the relationship between ASM polytherapy and QOL in epilepsy patients, considering clinical, sociodemographic, and psychological variables.
This review followed the PRISMA guidelines and was registered in PROSPERO. The studies examined were collected from PubMed/MEDLINE, Scopus, Web of Science, and Embase. The data extracted were categorized into three categories: therelationship between the number of ASMs and QOL, differences in QOL between patients taking polytherapy and patients taking monotherapy, and therole of other variables on QOL.
The review included 34 studies. Thirty examined the relationship between the number of ASMs and QOL, 93.3% of them identifying a significant association between a higher number of ASMs and poorer QOL. Fifteen studies analyzed differences in QOL between patients receiving polytherapy and those on monotherapy, all of them showing poorer QOL in those on polytherapy. Thirty-two studies considered other factors beyond polytherapy as determinants of QOL, including clinical, sociodemographic, and psychological variables, and higher seizure frequency and mood comorbidities (depression and anxiety) emerged as the strongest predictors of poor QOL.
Polytherapy, despite being necessary for managing drug-resistant epilepsy, significantly contributes to impairing QOL. Effective seizure control remains critical, but a multifactorial approach addressing mental health and social determinants is essential for improving QOL in epilepsy patients. Future research should focus on optimizing treatment strategies that balance seizure control by minimizing the negative impact of polytherapy.
耐药性癫痫通常需要联合使用抗癫痫药物（ASMs）进行治疗，这可能会带来一些副作用和不良反应，从而影响生活质量（QOL）。本系统综述总结了关于癫痫患者中ASM联合治疗与生活质量之间关系的证据，同时考虑了临床、社会人口统计学和心理变量。
本综述遵循PRISMA指南，并在PROSPERO中进行了注册。所审查的研究从PubMed/MEDLINE、Scopus、Web of Science和Embase中收集。提取的数据分为三类：ASM数量与生活质量的关系、接受联合治疗的患者与接受单一疗法的患者在生活质量上的差异，以及其他变量对生活质量的影响。
该综述纳入了34项研究。30项研究考察了ASM数量与生活质量的关系，其中93.3%的研究发现ASM数量越多与生活质量越差之间存在显著关联。15项研究分析了接受联合治疗的患者与接受单一疗法的患者在生活质量上的差异，所有研究均表明接受联合治疗的患者生活质量较差。32项研究考虑了联合治疗以外的其他因素作为生活质量的决定因素，包括临床、社会人口统计学和心理变量，癫痫发作频率较高以及情绪共病（抑郁和焦虑）是生活质量差的最强预测因素。
联合治疗尽管对于耐药性癫痫的管理是必要的，但对生活质量有显著的负面影响。有效的癫痫控制仍然至关重要，但采用多因素方法解决心理健康和社会决定因素对于改善癫痫患者的生活质量至关重要。未来的研究应侧重于优化治疗策略，通过尽量减少联合治疗的负面影响来平衡癫痫控制。
