1. Are illness perceptions a predictor of quality of life in epilepsy and psychogenic non-epileptic seizures ?
Gregg Rawlings, Markus Reuber
Academic Neurology Unit, University of Sheffield, UK
Introduction
Compared to PNES, patients with epilepsy considered their condition as less threatening; more likely to be controlled by personal and treatment factors, as having fewer consequences on their life, causing fewer of their symptoms, and as having a lower emotional impact.
Health-related quality of life (HRQoL) is reduced in epilepsy and psychogenic nonepileptic seizures (PNES).
Research suggests psychological factors (e.g. depression, anxiety) account for the largest variance in HRQoL when compared to condition-related (e.g. seizure activity) and demographic variables 1,2.
Patients’ illness perceptions have been shown to be associated with HRQoL in other conditions 3.
Table 2. Spearman’s rank correlation coefficient between HRQoL and demographic, condition and psychological variables
Aims
To investigate the condition and psychological profile of patients with epilepsy and PNES.
To examine the relationship and predictive power of psychological (illness perception, depression, anxiety), condition-related (seizure activity) and demographic factors on HRQoL in epilepsy and PNES.
Hierarchical Multiple Regression Analysis:
In epilepsy and PNES, anxiety and depression (epilepsy: 27%; PNES: 24.8%) and illness perceptions (epilepsy: 23.1%; PNES: 23.3%) accounted for the largest amount of variance in HRQoL.
Condition-related factors were not significant predictors.
Demographic factors predicted HRQoL in epilepsy (12.6%), but not in PNES.
Method
Patients were recruited from outpatient neurology clinics at the Royal Hallamshire Hospital, Sheffield (UK) and membership-led organisations for individuals who experience seizures.
Patients
Epilepsy N = 62, PNES N = 45
Measures
Anxiety (GAD-7), depression (NDDI-E), illness perceptions (B-IPQ), HRQoL (NEWQOL-6D), seizures frequency and severity (LSSS-3)
R2=65.3%
R2=61.9%
Results
Demographic, condition and psychological profile of patients:
Patients were matched on age, education and severity of seizures.
Patients with epilepsy had experienced seizures for longer and experienced less seizures within the last four weeks.
Epilepsy
PNES
Conclusion
Table 1 Mann-Whitney-U analysis and chi-square test. Scores reflect median (IQR)
Patients with epilepsy reported higher HRQoL and lower levels of depression and anxiety than PNES.
Individuals with PNES perceived their condition as more threatening overall.
Psychological factors, including illness perceptions, were the greatest predictors of HRQoL in epilepsy and PNES compared to demographic and condition-related factors.
Treatment pathways for patients with epileptic or nonepileptic seizures should manage patients’ beliefs about their condition, in addition to treating symptoms of comorbidity and seizure activity.
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