Determinants of quality of life in patients with drug-resistant focal epilepsy.

INTRODUCTION: Focal drug-resistant epilepsy (DRE) has been associated with a significant burden of psychiatric comorbidity and low health-related quality of life (HRQoL). There is ample disagreement in previous studies as to which factors decisively influence HRQoL in this population. Here, we sought to assess the relationship between sociodemographic factors, epilepsy-related variables, and psychiatric comorbidity with HRQoL in a well-defined group of patients with focal DRE. METHODS: We consecutively recruited a sample of adult patients with confirmed focal DRE being considered for epilepsy surgery in a reference center in Lisbon, Portugal. Psychiatric diagnoses were defined according to the Mini-International Neuropsychiatric Interview (M.I.N.I.), and HRQoL was measured using the Quality-of-Life in Epilepsy Inventory (QOLIE-31). Associations with QOLIE-31 total score were tested using regression models. RESULTS: Among the forty patients included in the study, being diagnosed with a mood disorder was significantly associated with a lower total QOLIE-31 score (ß = -21.18, p = 0.001) in univariate analysis. Multivariate analysis additionally identified female gender as a second determinant of lower HRQoL (ß = -21.22, p = 0.001 for being diagnosed with a mood disorder; ß = -8.98, p = 0.048 for female gender; adjusted R2 = 0.290). Sociodemographic and epilepsy-related variables were not associated with HRQoL. CONCLUSIONS: In our sample of adult patients with focal DRE, female gender and being diagnosed with a mood disorder were the only factors significantly associated with a poorer HRQoL. While clinical care often focuses on seizure control, epilepsy-related factors such as seizure frequency were not shown to have a significant influence on HRQoL. We suggest that an early comprehensive psychiatric evaluation and intervention can help improve HRQoL in these patients.