Drug-treatment changes, depression, and quality of life in adults with drug-resistant focal epilepsy.

drug changes and quality of life in the community

Anxiety, Depression, and Health-Related Quality of Life in Family Caregivers of Patients with Epilepsy

Epilepsy is a chronic neurological disorder that imposes substantial physical, psychological, and social burdens not only on patients but also on their family caregivers. Although psychiatric comorbidities and impaired quality of life have been extensively investigated in patients with epilepsy, the psychological well-being and health-related quality of life of their caregivers remain insufficiently studied. This study aimed to evaluate anxiety, depression, and health-related quality of life among family caregivers of patients with epilepsy and to identify patient-related factors associated with these outcomes. The study included three groups: patients with epilepsy, their caregivers, and healthy controls. Differences in scale scores between two groups were analyzed using the independent-samples t -test, whereas comparisons among three or more groups were performed using one-way analysis of variance (ANOVA). Associations between categorical variables were evaluated using Pearson's chi-square test or the likelihood ratio test, depending on the distribution of the data. Pearson's correlation coefficient was calculated for continuous variables. A p -value of <0.05 was considered statistically significant. Caregivers of patients with epilepsy had significantly higher anxiety and depression scores than healthy controls. These findings indicate an increased prevalence of anxiety and depressive symptoms among caregivers. Furthermore, evaluation of quality of life using the Short Form-36 (SF-36) questionnaire demonstrated significant impairment across all quality-of-life domains in the caregiver group. The findings suggest that being a caregiver of a patient with epilepsy is, by itself, an important factor adversely affecting emotional well-being and quality of life. Changes in caregivers' mood status and quality of life were not associated with the patients' sex, seizure type, or seizure frequency.

A study on the quality of life of children with epilepsy and the impact of disease on family functioning

Background: Epilepsy is one of the most common chronic neurological disorders in childhood and is associated with significant physical, emotional, social, and educational consequences. Beyond seizure control, children with epilepsy often experience impaired health-related quality of life (HRQoL), while their caregivers face substantial psychosocial burden. So, the study is aimed to assess the QoL of children with epilepsy and to evaluate the impact of the disease on family functioning. Methods: This hospital-based prospective observational study was conducted in the Department of Paediatrics at Hi-Tech Medical College and Hospital over a period of January 2024 to December 2025. A total of 110 children aged 8-12 years with epilepsy and their primary caregivers were included. Data on demographic and clinical variables were collected using a structured proforma. QoL was assessed using the Pediatric QoL Inventory (PedsQL™ 4.0 Generic core scales) and family functioning was evaluated using the PedsQL™ family impact module. Statistical analysis was performed using SPSS version 26, with p<0.05 considered statistically significant. Results: The mean age of participants was 9.95±1.42 years, with a male predominance (59.1%). The mean QoL score was 66.20±13.45, indicating moderate impairment, with emotional functioning being the most affected domain. The mean family impact score was 60.67±14.42. Children with uncontrolled seizures had significantly lower QoL scores compared to those with controlled seizures (p<0.001). Polytherapy and the presence of comorbidities were also associated with poorer QoL and greater family burden. Conclusions: Childhood epilepsy significantly impairs QoL and adversely affects family functioning. Clinical factors such as seizure control, treatment complexity, and comorbidities are key determinants of these outcomes. These findings highlight the need for a comprehensive, multidisciplinary, and family-centered approach to epilepsy management that extends beyond seizure control.

Determinants of health-related quality of life in pediatric epilepsy: the impact of treatment tolerability and epilepsy type

Background Health-related quality-of-life (HRQOL) is a central outcome in pediatric epilepsy, yet the relative influence of disease severity versus treatment-related burden remains unclear. This study aimed to evaluate HRQOL and assess the respective contributions of clinical characteristics and treatment adverse events in children with epilepsy. Methods A cross-sectional analysis of 101 children enrolled in a prospective cohort in Lebanon was conducted. HRQOL was assessed using the Arabic QOLCE-55, and treatment-related adverse effects were measured using the Liverpool Adverse Events Profile (LAEP). Multivariable linear regression models, including hierarchical domain-specific analyses, were used to identify factors independently associated with HRQOL. Results HRQOL was moderately reduced, with a median QOLCE-55 score of 66 (IQR 55.68–79.41). The physical domain was the most affected (44.44; IQR 30.55–59.72), while the social domain was the least impaired (82.14; IQR 67.85–96.42). In multivariable analysis, higher adverse-effect burden was the strongest factor associated with poorer overall HRQOL (B = −0.97, 95% CI –1.28 to −0.67; p < 0.001), whereas most seizure-related variables were not significant after adjustment. Inclusion of LAEP substantially improved model performance (ΔR2 up to 0.310) and was associated with poorer HRQOL across all domains. Longer epilepsy duration remained associated with poorer physical HRQOL, and focal epilepsy with lower social and emotional scores. Conclusion In this cohort, HRQOL was more strongly associated with treatment-related adverse effects than with most seizure-related variables. Treatment tolerability appears to represent an important and modifiable correlate of well-being. Routine assessment of adverse effects may enhance patient-centered care.

Clinical relevance of seizure self-efficacy in pediatric epilepsy: Its associations with depression and anxiety.

BACKGROUND Although seizure self-efficacy is recognized as an important factor in epilepsy management, its relationship with psychological outcomes such as depression and anxiety in pediatric populations remains underexplored. This study aimed to evaluate seizure self-efficacy in children and adolescents with epilepsy and to examine its associations with depression, anxiety, and relevant clinical and psychosocial factors. METHODS This cross-sectional observational study included 121 patients aged 9-17 years with epilepsy. Seizure self-efficacy was assessed using the Seizure Self-Efficacy Scale for Children (SSES-C), while depressive symptoms and anxiety levels were measured using the Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children (STAIC). Associations were analyzed using correlation and group comparison tests, and multivariable logistic regression was performed to identify independent predictors of depression. RESULTS The median age was 14 years (IQR: 12-15), and 53.7% were male. The median self-efficacy score was 3.80 (IQR: 3.20-4.40). Seizure self-efficacy was significantly and inversely correlated with depression (r =  - 0.546), state anxiety (r =  - 0.437), and trait anxiety (r =  - 0.348) (all p < 0.001). Depression showed strong positive correlations with both anxiety measures. Patients with lower self-efficacy had higher depression and anxiety scores, with a clear gradient across levels. In multivariable analysis, lower self-efficacy remained independently associated with depression (OR: 0.35, p = 0.001). Lower income and lack of family support were also independent risk factors. CONCLUSION Seizure self-efficacy is closely associated with psychological outcomes in pediatric epilepsy and may represent a modifiable risk factor for depression. These findings support routine assessment and targeted interventions, although they should be interpreted in light of the study's single-center, cross-sectional design and reliance on self-reported measures, which may limit generalizability and preclude causal inferences.

VENI, VIDI, VICI: The advantage of early epilepsy surgery in drug-sensitive patients.

OBJECTIVE Surgical intervention is frequently considered for drug-resistant focal structural epilepsy. However, the impact of early surgery on seizure control, cognitive performance, and quality of life (QoL) across drug-sensitive and drug-resistant patients remains incompletely characterized. METHODS We conducted a prospective-retrospective study on 214 patients with age > 6 years with focal structural epilepsy (focal cortical dysplasia type II, hippocampal sclerosis, low-grade epilepsy-associated tumors) stratified as: drug-sensitive (DS, n = 72) and drug-resistant (DR, n = 112) patients undergoing surgery, and drug-resistant patients on pharmacological treatment (DRT, n = 30). Cognitive function (including language, verbal and visuospatial memory, attention/executive functions) and QoL (using the Quality of Life in Epilepsy Inventory [QOLIE] and 36-Item Short Form Survey [SF-36] questionnaires) were assessed at baseline and 1-year follow-up in patient subgroups. Statistical analyses included chi-square tests, t tests, analysis of variance (ANOVA), and multivariable regression models; p < .05 was considered statistically significant. RESULTS The DS patients demonstrated superior rates of complete seizure freedom (86%) compared with DR patients (69%, p = .009). At baseline, DS patients exhibited significantly fewer cognitive deficits compared with DR and DRT patients (p < .05). At the 1-year follow-up, no significant changes in neuropsychological performance were observed in any group, although a mild decline in verbal and/or visuospatial memory performance was observed in DRT patients. In a subset of patients (n = 59 adults) at baseline, DR and DRT patients reported significantly worse overall subjective QoL compared with DS patients (p = .047 and p = .036, respectively). Longitudinal analysis revealed significant improvements in QoL among surgically treated patients. SIGNIFICANCE Early epilepsy surgery in symptomatic focal epilepsy yields excellent seizure outcomes, particularly in DS patients. Baseline preservation of cognitive function and QoL, together with the stability of these measures after surgery, suggests that timely surgery may help prevent deterioration in cognitive and psychosocial functioning. These findings support early referral for surgical evaluation in selected patients and highlight the need for larger studies with extended follow-up, to confirm surgical outcome, long-term neuropsychological, and patient-reported benefits.