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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Health related quality of life in patients with epilepsy in
Turkey</title><author><name sortKey="Mutluay, Fatma Karantay" sort="Mutluay, Fatma Karantay" uniqKey="Mutluay F" first="Fatma Karantay" last="Mutluay">Fatma Karantay Mutluay</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Gunduz, Aysegul" sort="Gunduz, Aysegul" uniqKey="Gunduz A" first="Aysegul" last="Gunduz">Aysegul Gunduz</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Tekeoglu, An L" sort="Tekeoglu, An L" uniqKey="Tekeoglu A" first="An L" last="Tekeoglu">An L Tekeoglu</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Oguz, Semra" sort="Oguz, Semra" uniqKey="Oguz S" first="Semra" last="Oguz">Semra Oguz</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Yeni, Seher Naz" sort="Yeni, Seher Naz" uniqKey="Yeni S" first="Seher Naz" last="Yeni">Seher Naz Yeni</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26957766</idno><idno type="pmc">4756012</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756012</idno><idno type="RBID">PMC:4756012</idno><idno type="doi">10.1589/jpts.28.240</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000774</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000774</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Health related quality of life in patients with epilepsy in
Turkey</title><author><name sortKey="Mutluay, Fatma Karantay" sort="Mutluay, Fatma Karantay" uniqKey="Mutluay F" first="Fatma Karantay" last="Mutluay">Fatma Karantay Mutluay</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Gunduz, Aysegul" sort="Gunduz, Aysegul" uniqKey="Gunduz A" first="Aysegul" last="Gunduz">Aysegul Gunduz</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Tekeoglu, An L" sort="Tekeoglu, An L" uniqKey="Tekeoglu A" first="An L" last="Tekeoglu">An L Tekeoglu</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Oguz, Semra" sort="Oguz, Semra" uniqKey="Oguz S" first="Semra" last="Oguz">Semra Oguz</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Yeni, Seher Naz" sort="Yeni, Seher Naz" uniqKey="Yeni S" first="Seher Naz" last="Yeni">Seher Naz Yeni</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>[Purpose] This study measured the quality of life in epilepsy and determined
associated demographic and clinical factors by means of the Short Form-36 health survey.
[Subjects and Methods] 124 consecutive epilepsy patients were enrolled and their
demographic variables and clinical characteristics recorded. The Short Form-36
questionnaire was completed independently by each participant. Short Form-36 dimensional
and composite scores were computed and scaled with data from an extensive survey of the
healthy population. [Results] Short Form-36 scores for physical dimensions were similar to
healthy values, but those for mental dimensions except for energy/vitality were remarkably
and significantly lower than normal. All Short Form-36 average scores for women were lower
than those for men and significantly so for mental health composite scores. Patients
responding well to treatment were aware of their improving health as measured by the
Change in Health score and had better dimensional scores than those with a poor response.
[Conclusion] Patients with epilepsy do not perceive impaired physical health status.
However, their mental health appears vulnerable, especially in women. Therefore, the major
burden in epilepsy is in the mental health category. A positive treatment response is also
an important determinant of the related quality of life measure.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Cramer, Ja" uniqKey="Cramer J">JA Cramer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alonso Vanegas, Ma" uniqKey="Alonso Vanegas M">MA Alonso-Vanegas</name></author><author><name sortKey="Cisneros Franco, Jm" uniqKey="Cisneros Franco J">JM Cisneros-Franco</name></author><author><name sortKey="Castillo Montoya, C" uniqKey="Castillo Montoya C">C Castillo-Montoya</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jacoby, A" uniqKey="Jacoby A">A Jacoby</name></author><author><name sortKey="Sudell, M" uniqKey="Sudell M">M Sudell</name></author><author><name sortKey="Tudur Smith, C" uniqKey="Tudur Smith C">C Tudur Smith</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, Ek" uniqKey="Johnson E">EK 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26957766</article-id><article-id pub-id-type="pmc">4756012</article-id><article-id pub-id-type="publisher-id">jpts-2015-766</article-id><article-id pub-id-type="doi">10.1589/jpts.28.240</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Health related quality of life in patients with epilepsy in
Turkey</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Mutluay</surname><given-names>Fatma Karantay</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gunduz</surname><given-names>Aysegul</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tekeoglu</surname><given-names>Anıl</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Oguz</surname><given-names>Semra</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yeni</surname><given-names>Seher Naz</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><aff id="aff1"><label>1)</label> Division of Physical Therapy and Rehabilitation, Faculty of Health Science, Istanbul Medipol University, Turkey</aff><aff id="aff2"><label>2)</label> Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey</aff><aff id="aff3"><label>3)</label> Division of Physical Therapy and Rehabilitation, Faculty of Health Science, Marmara University, Turkey</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Fatma Karantay Mutluay, Division of Physical Therapy and Rehabilitation, Faculty of
Health Science, Istanbul Medipol University: Kavacık Mah, Ekinciler Cad, No: 19 Beykoz
34810 Istanbul, Turkey. (E-mail:
<email xlink:href="fatmamutluay@yahoo.com">fatmamutluay@yahoo.com</email>)</corresp></author-notes><pub-date pub-type="epub"><day>30</day><month>1</month><year>2016</year></pub-date><pub-date pub-type="ppub"><month>1</month><year>2016</year></pub-date><volume>28</volume><issue>1</issue><fpage>240</fpage><lpage>245</lpage><history><date date-type="received"><day>14</day><month>9</month><year>2015</year></date><date date-type="accepted"><day>16</day><month>10</month><year>2015</year></date></history><permissions><copyright-statement>2016©by the Society of Physical Therapy Science. Published by IPEC
Inc.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. </license-p></license></permissions><abstract><p>[Purpose] This study measured the quality of life in epilepsy and determined
associated demographic and clinical factors by means of the Short Form-36 health survey.
[Subjects and Methods] 124 consecutive epilepsy patients were enrolled and their
demographic variables and clinical characteristics recorded. The Short Form-36
questionnaire was completed independently by each participant. Short Form-36 dimensional
and composite scores were computed and scaled with data from an extensive survey of the
healthy population. [Results] Short Form-36 scores for physical dimensions were similar to
healthy values, but those for mental dimensions except for energy/vitality were remarkably
and significantly lower than normal. All Short Form-36 average scores for women were lower
than those for men and significantly so for mental health composite scores. Patients
responding well to treatment were aware of their improving health as measured by the
Change in Health score and had better dimensional scores than those with a poor response.
[Conclusion] Patients with epilepsy do not perceive impaired physical health status.
However, their mental health appears vulnerable, especially in women. Therefore, the major
burden in epilepsy is in the mental health category. A positive treatment response is also
an important determinant of the related quality of life measure.</p></abstract><kwd-group><title>Key words</title><kwd>Epilepsy</kwd><kwd>Quality of life</kwd><kwd>SF-36</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>INTRODUCTION</title><p>Successful treatment is traditionally assessed by the extent of seizure control. However,
quality of life (QoL) has recently attracted more attention because it reveals complaints
regarding attention, learning, physical pain, anxiety, and sleep<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>.</p><p>Health related QoL-associated factors for epilepsy have been linked to adverse drug
effects<xref rid="r2" ref-type="bibr">2</xref>, <xref rid="r3" ref-type="bibr">3</xref><sup>)</sup>, demographic variables, concurrent medical, psychiatric<xref rid="r4" ref-type="bibr">4</xref>,<xref rid="r5" ref-type="bibr">5</xref>,<xref rid="r6" ref-type="bibr">6</xref><sup>)</sup> and psychosocial problems<xref rid="r7" ref-type="bibr">7</xref><sup>)</sup>, onset of seizures early life, loss of
consciousness during seizures<xref rid="r8" ref-type="bibr">8</xref>, <xref rid="r9" ref-type="bibr">9</xref><sup>)</sup> and the frequency of seizures<xref rid="r2" ref-type="bibr">2</xref>, <xref rid="r8" ref-type="bibr">8</xref><sup>)</sup>.</p><p>The Short Form-36 (SF-36) Health Survey is the most widely used generic self rating<xref rid="r10" ref-type="bibr">10</xref><sup>)</sup> and internationally recognized global
measure of QoL<xref rid="r11" ref-type="bibr">11</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r13" ref-type="bibr">13</xref>,<xref rid="r14" ref-type="bibr">14</xref>,<xref rid="r15" ref-type="bibr">15</xref><sup>)</sup>. The SF-36 consists of 36
questions, has the advantages of easy administration and ability to measure the impact of a
disease and related treatments on both physical and mental health<xref rid="r15" ref-type="bibr">15</xref>, <xref rid="r16" ref-type="bibr">16</xref><sup>)</sup>. It has been
validated for measuring health perception in a general population<xref rid="r17" ref-type="bibr">17</xref><sup>)</sup>, translated and validated for use in more than 40
countries, including Turkey<xref rid="r18" ref-type="bibr">18</xref><sup>)</sup>.</p><p>The present study aimed to determine QoL and associated demographic and clinical factors in
an epilepsy cohort in a tertiary epilepsy center by means of the SF-36.</p></sec><sec sec-type="methods" id="s2"><title>SUBJECTS AND METHODS</title><sec><title>Subjects</title><p>This was a prospective, case-control study. Consecutive patients admitted to the epilepsy
outpatient clinic during the study period (October 2013 to April 2014) were enrolled.
Those who were illiterate, mentally retarded or who had concomitant chronic systemic
diseases were excluded.</p><p>This study was approved by the Istanbul University Ethics Committee (Ref.
B.30.2.IST.0.30.90.00/4450). All participants gave their informed consent.</p><p>The clinical types of epilepsy syndromes and seizures were identified according to 1981
and 1989 ILAE classifications, respectively<xref rid="r19" ref-type="bibr">19</xref>,
<xref rid="r20" ref-type="bibr">20</xref><sup>)</sup>. Age, gender, level of education,
marital and occupational status, age at disease onset, disease duration, and treatment in
the last year were recorded. Poor response to treatment was defined as the occurrence of a
seizure without any inciting factor whereas good response was defined as freedom from
seizures.</p><p>The participants themselves completed the questionnaire alone in a room. One researcher
trained in the application of this questionnaire retrieved each form just after its
completion.</p><p>SF-36 questionnaire evaluation provides separate raw category scores on a scale of 0 to
100 for eight aspects (dimensions) which have been defined as Physical Functioning (PF),
Role-Physical (RP), Bodily Pain (BP), General Health perception (GH), Energy-Vitality
(VT), Social Functioning (SF), Role-Emotional (RE) and Mental Health (MH)<xref rid="r15" ref-type="bibr">15</xref><sup>)</sup>. It provides scores for predominently
“physical” (PF, RP, BP, GH) and “mental” (VT, SF, RE, MH) dimensions. Change in Health
(CH) perception during the last year is also assessed by evaluating a five-level graded
response to a single question. Summary measures of physical and mental health are
constructed by computing Physical (PHC) and Mental (MHC) Health Composite scores as
differently weighted averages of the eight SF-36 dimensional scores<xref rid="r21" ref-type="bibr">21</xref><sup>)</sup>.</p><p>Data evaluation and Statistical analysis: All raw scores were scaled with normative
statistical data obtained from a large sample of the healthy population<xref rid="r18" ref-type="bibr">18</xref><sup>)</sup>. The scaling procedure used normalizes
each raw and composite score with respect to a mean equal to 50 representing the healthy
population normative average score and to 10 units of scaled standard deviation (SD)
equivalent to one SD of the normative sample<xref rid="r22" ref-type="bibr">22</xref><sup>)</sup>. By this definition, all scaled dimensional and composite scores
have a mean of 50 and SD of 10 for the healthy population. Thus, each 10-point score
difference from 50 represents one SD from the healthy population mean score: e.g. a
patient scoring 30 is 2 SD below normal i.e. at the same level as the bottom 2.5% of a
normally distributed healthy population.</p><p>Statistical significance was calculated using Student’s t-test when distributed
homogeneously and using Mann Whitney U test when distributed heterogeneously for numerical
data (the choice was made by the use of the F-test), the χ<sup>2</sup> was used for
non-parametric data. Pearson’ linear correlation was constructed to analyze the
relationship between demographic/clinical features and SF-36 subscale and total
scores.</p></sec></sec><sec sec-type="results" id="s3"><title>RESULTS</title><p>During the survey period, 154 patients were enrolled. Results for 30 patients were not
included as 13 could not complete the SF-36 questionnaire appropriately, seven had
conversion disorders and 10 had nonepileptic diseases. Data from the remaining 124 patients
(57 males, 46%) were subjected to statistical analysis (<xref rid="tbl_001" ref-type="table">Table 1</xref><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title>Demographics and clinical characteristics of the epilepsy patients
(n=124)</title></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="center" rowspan="1" colspan="1">Demographic variables </th><th valign="top" align="left" rowspan="1" colspan="1"></th><th valign="top" align="center" rowspan="1" colspan="1">Clinical variables</th><th valign="top" align="left" rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age at follow-up (years)</td><td align="center" valign="top" rowspan="1" colspan="1">27.1 ± 11.4</td><td align="left" valign="top" rowspan="1" colspan="1">Disease duration (years)</td><td align="center" valign="top" rowspan="1" colspan="1">8.3±9.0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Gender (Male–Female)</td><td align="center" valign="top" rowspan="1" colspan="1">57 (45%)–67 (55%)</td><td align="left" valign="top" rowspan="1" colspan="1">Age at onset (years)</td><td align="center" valign="top" rowspan="1" colspan="1">18.8±9.9</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Education</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Type of epilepsy</td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">≤5 years </td><td align="center" valign="top" rowspan="1" colspan="1"> 36 (29%) </td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Partial</td><td align="center" valign="top" rowspan="1" colspan="1">78 (63%)</td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">≤8 years</td><td align="center" valign="top" rowspan="1" colspan="1"> 25 (20%) </td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Generalized</td><td align="center" valign="top" rowspan="1" colspan="1">20 (16%)</td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">≤11 years </td><td align="center" valign="top" rowspan="1" colspan="1"> 32 (26%)</td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Unknown </td><td align="center" valign="top" rowspan="1" colspan="1">26 (21%)</td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">≤15 years</td><td align="center" valign="top" rowspan="1" colspan="1"> 29 (23%)</td><td align="left" valign="top" rowspan="1" colspan="1">Type of seizure</td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">>15 years</td><td align="center" valign="top" rowspan="1" colspan="1"> 2 (2%)</td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">CPS</td><td align="center" valign="top" rowspan="1" colspan="1">35 (28%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Work status </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">SGTC, GTC</td><td align="center" valign="top" rowspan="1" colspan="1">15 (12%)</td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Working</td><td align="center" valign="top" rowspan="1" colspan="1">32 (26%)</td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">CPS, SGTC, SP</td><td align="center" valign="top" rowspan="1" colspan="1">30 (25%)</td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Not working</td><td align="center" valign="top" rowspan="1" colspan="1">53 (43%)</td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Absence, Myoclonus, GTC</td><td align="center" valign="top" rowspan="1" colspan="1">20 (16%)</td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Student </td><td align="center" valign="top" rowspan="1" colspan="1">34 (27%)</td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Unknown</td><td align="center" valign="top" rowspan="1" colspan="1">24 (19%)</td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Unknown </td><td align="center" valign="top" rowspan="1" colspan="1">5 (4%)</td><td align="left" valign="top" rowspan="1" colspan="1">Number of AEDs</td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Marital status</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Polytherapy</td><td align="center" valign="top" rowspan="1" colspan="1">32 (26%)</td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Married</td><td align="center" valign="top" rowspan="1" colspan="1">43 (35%)</td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Monotherapy</td><td align="center" valign="top" rowspan="1" colspan="1"> 63 (51%) </td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Single </td><td align="center" valign="top" rowspan="1" colspan="1">53 (43%) </td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">No treatment</td><td align="center" valign="top" rowspan="1" colspan="1">3 (2%)</td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Widow</td><td align="center" valign="top" rowspan="1" colspan="1">3 (2%)</td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Unknown</td><td align="center" valign="top" rowspan="1" colspan="1">26 (21%) </td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Pediatric (<18 years)</td><td align="center" valign="top" rowspan="1" colspan="1">16 (13%)</td><td align="left" valign="top" rowspan="1" colspan="1">Response to treatment</td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Unknown </td><td align="center" valign="top" rowspan="1" colspan="1">9 (7 %)</td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Good</td><td align="center" valign="top" rowspan="1" colspan="1"> 47 (38%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Poor</td><td align="center" valign="top" rowspan="1" colspan="1">45 (36%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" style="padding-left:10pt" rowspan="1" colspan="1">Unknown </td><td align="center" valign="top" rowspan="1" colspan="1">32 (26%)</td></tr></tbody></table><table-wrap-foot><p>AED: antiepileptic drugs; CPS: complex partial seizure; SGTC: secondary generalized
tonic-clonic; GTC: generalized tonic-clonic; SP: simple partial</p></table-wrap-foot></table-wrap>).</p><p><italic>Overall analysis –QoL results for all epilepsy patients</italic>: SF-36 scores for
physical dimensions PF and BP as well as for PHC of patients with epilepsy were similar to
healthy population values (<xref rid="tbl_002" ref-type="table">Table 2</xref><table-wrap id="tbl_002" orientation="portrait" position="float"><label>Table 2.</label><caption><title>Health quality of life in all epilepsy patients and comparisons according to
gender</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1">Parameters<sup>†</sup></th><th align="center" rowspan="1" colspan="1">All cases (n=124)</th><th align="center" rowspan="1" colspan="1">Male (n=57)</th><th align="center" rowspan="1" colspan="1">Female (n=67)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Physical Function (PF)</td><td align="center" rowspan="1" colspan="1">48.6±10.2</td><td align="center" rowspan="1" colspan="1">49.4± 9.1</td><td align="center" rowspan="1" colspan="1">47.9±11.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Role Physical (RP)</td><td align="center" rowspan="1" colspan="1">45.2±11.5*</td><td align="center" rowspan="1" colspan="1">46,4±10.3</td><td align="center" rowspan="1" colspan="1">44.2±12.4*</td></tr><tr><td align="left" rowspan="1" colspan="1">Body Pain (BP)</td><td align="center" rowspan="1" colspan="1">49.8±11.2</td><td align="center" rowspan="1" colspan="1">51.2±10.1</td><td align="center" rowspan="1" colspan="1">48.7±12.1</td></tr><tr><td align="left" rowspan="1" colspan="1">General Health (GH)</td><td align="center" rowspan="1" colspan="1">44.2±9.7*</td><td align="center" rowspan="1" colspan="1">44.3±10.0*</td><td align="center" rowspan="1" colspan="1">44.0±9.5*</td></tr><tr><td align="left" rowspan="1" colspan="1">Energy / Vitality (VT)</td><td align="center" rowspan="1" colspan="1">48.5±10.9</td><td align="center" rowspan="1" colspan="1">51.2±11.1 ¶</td><td align="center" rowspan="1" colspan="1">46.3±10.3*</td></tr><tr><td align="left" rowspan="1" colspan="1">Social Function (SF)</td><td align="center" rowspan="1" colspan="1">37.0±6.2*</td><td align="center" rowspan="1" colspan="1">36.9±6.5*</td><td align="center" rowspan="1" colspan="1">37.0±6.1*</td></tr><tr><td align="left" rowspan="1" colspan="1">Role Emotional (RE)</td><td align="center" rowspan="1" colspan="1">42.8±11.8*</td><td align="center" rowspan="1" colspan="1">44.8±10.7*</td><td align="center" rowspan="1" colspan="1">41.1±13.2*</td></tr><tr><td align="left" rowspan="1" colspan="1">Mental Health (MH)</td><td align="center" rowspan="1" colspan="1">40.2±11.6*</td><td align="center" rowspan="1" colspan="1">42.1±11.0*</td><td align="center" rowspan="1" colspan="1">38.6±12.0*</td></tr><tr><td align="left" rowspan="1" colspan="1">Change in Health (CH)</td><td align="center" rowspan="1" colspan="1">53.2±10.0*</td><td align="center" rowspan="1" colspan="1">54.5±9.4</td><td align="center" rowspan="1" colspan="1">52.0±10.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Physical Health Composite (PHC)</td><td align="center" rowspan="1" colspan="1">49.9±9.3</td><td align="center" rowspan="1" colspan="1">50.2±9.1</td><td align="center" rowspan="1" colspan="1">49.6±9.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Mental Health Composite (MHC) </td><td align="center" rowspan="1" colspan="1">39.3±10.2*</td><td align="center" rowspan="1" colspan="1">41.4±10.0* ¶</td><td align="center" rowspan="1" colspan="1">37.5±10.2*</td></tr></tbody></table><table-wrap-foot><p><sup>†</sup>All scores are shown as mean±standard deviation (SD) and
scaled with respect to those of reference healthy population whose normalized scores
are 50±10 i.e. a 10-point score difference represents one SD. *Significantly different from healthy population value (p<0.05, Student’s
t-test). <sup>¶</sup>Significantly different from women (p<0.05, Student’s t-test)</p></table-wrap-foot></table-wrap>), but those for RP and GH were lower by 1/2 SD (both p≅0). However, SF-36
scores for MHC and for all mental dimensions except VT were ≈1 SD lower than normal (all
p≅0).</p><p>Dispersions of SF-36 scores around their mean were similar (9.3≤SD≤11.8, p<0.01) to
those of the healthy population (SD≡ 10) except for SF (SD = 6.2, p≅0).</p><p><italic>Subgroup analysis -QoL results according to demographic
characteristics</italic>:<italic></italic>Almost all SF-36 average scores were lower for female
patients but were more significantly different from those of males only for VT (p<2%) and
MHC (p<5%) (<xref rid="tbl_002" ref-type="table">Table 2</xref>). No dissimilarities due
to marital status and occupation were detected.</p><p><italic>Subgroup analysis -QoL results according to clinical characteristics</italic>: No
dissimilarities due to the treatment method or epilepsy and seizure types were detected.
SF-36 scores for patients with generalized and partial epilepsy were similar except for SF
which was lower in generalized epilepsy patients.</p><p><italic>Subgroup analysis -QoL results according to response to treatment</italic>:
Significant disparity in GH, VT, MH (all p<1%) and MHC (p<2%) scores were found in
favor of patients who responded positively to treatment compared to those not treated or who
did not respond well to treatment (<xref rid="tbl_003" ref-type="table">Table
3</xref><table-wrap id="tbl_003" orientation="portrait" position="float"><label>Table 3.</label><caption><title>Comparisons of health quality of life according to response to antiepileptic
treatment.</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1">Parameters<sup>†</sup></th><th align="center" rowspan="1" colspan="1">Good response (n=47)</th><th align="center" rowspan="1" colspan="1">Poor response (n=45)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Physical Function (PF)</td><td align="center" rowspan="1" colspan="1">49.6±8.7</td><td align="center" rowspan="1" colspan="1">47.7±11.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Role Physical (RP)</td><td align="center" rowspan="1" colspan="1">46.6±11.1</td><td align="center" rowspan="1" colspan="1">43.5±11.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Body Pain (BP)</td><td align="center" rowspan="1" colspan="1">52.2±9.5</td><td align="center" rowspan="1" colspan="1">49.2±11.7</td></tr><tr><td align="left" rowspan="1" colspan="1">General Health (GH)*</td><td align="center" rowspan="1" colspan="1">47.9±8.5</td><td align="center" rowspan="1" colspan="1">41.3±8.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Energy / Vitality (VT)*</td><td align="center" rowspan="1" colspan="1">51.9±11.3</td><td align="center" rowspan="1" colspan="1">45.6±9.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Social Function (SF)</td><td align="center" rowspan="1" colspan="1">36.0±6.1</td><td align="center" rowspan="1" colspan="1">38.0±7.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Role Emotional (RE)</td><td align="center" rowspan="1" colspan="1">43.5±11.6</td><td align="center" rowspan="1" colspan="1">40.9±13.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Mental Health (MH)*</td><td align="center" rowspan="1" colspan="1">44.0±11.1</td><td align="center" rowspan="1" colspan="1">36.4±11.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Change in Health (CH)*</td><td align="center" rowspan="1" colspan="1">56.8±9.9</td><td align="center" rowspan="1" colspan="1">51.2±11.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Physical Health Composite (PHC)</td><td align="center" rowspan="1" colspan="1">51.6±7.8</td><td align="center" rowspan="1" colspan="1">49.0±9.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Mental Health Composite (MHC)** </td><td align="center" rowspan="1" colspan="1">41.4±10.0</td><td align="center" rowspan="1" colspan="1">36.6±9.8</td></tr></tbody></table><table-wrap-foot><p><bold><sup>†</sup></bold>All scores are shown as mean±standard deviation (SD) and
scaled with respect to those of reference healthy population whose normalized scores
are 50±10 i.e. a 10-point score difference represents one SD. *Significant difference exists between groups, p<0.05, Student’s t-test. **Significant difference exists between groups, p<0.05, Mann-Whitney U-test</p></table-wrap-foot></table-wrap>). While the CH for untreated and non-responsive patients (51.2±11.1) was
within the expected range, CH for responsive patients (56.8±9.9) was significantly higher
(p<5%).</p><p><italic>Correlation analysis</italic>: No SF-36 score was found to be correlated with age
at assessment, age at onset, disease duration or level of education. Moreover, no such
correlations were found in the segregated in the data segregated by gender.</p></sec><sec sec-type="discussion" id="s4"><title>DISCUSSION</title><p>In the present study, patients with epilepsy rated their physical status at the same level
as that of a healthy population as indicated by almost normal SF-36 PHC scores. SF-36
physical dimension scores only reflected significant weakness in GH and RP dimensions. All
physical dimension scores were gender-insensitive. In contrast, Mental Health Composite and
all predominantly mental SF-36 dimension scores, except for VT, were found to be
significantly ≈1 SD below mean healthy levels. Among these, uniformly (low dispersion) worse
by ≈1.5 SD and gender insensitive Social Function (SF) dimension scores were especially
notable since they indicate to a remarkably low self-perceived social status. Women with
epilepsy had consistently lower QoL scores than men and significantly so for VT and
especially for MHC indicating greater mental health vulnerability.</p><p>The efficacy of two generic (SF-36 and SF-12) and two specific epilepsy-targeted QoL
measures (QoLIE-89 and QoLIE-31) were previously compared in epilepsy<xref rid="r23" ref-type="bibr">23</xref><sup>)</sup>. SF-36 scores yielded comparable responsiveness indices
for assessing the degree of freedom from seizures. Generic QoL measures such as SF-36
correcty reflect the perspective of patients for many diseases, including neurological
conditions such as epilepsy<xref rid="r24" ref-type="bibr">24</xref>,<xref rid="r25" ref-type="bibr">25</xref>,<xref rid="r26" ref-type="bibr">26</xref><sup>)</sup>. Another major
advantage of SF-36 is the ability to compare the QoL of epilepsy patients with that of the
healthy population<xref rid="r17" ref-type="bibr">17</xref>, <xref rid="r23" ref-type="bibr">23</xref><sup>)</sup>.</p><p>Our results partially correlate with previous literature. In a smaller cohort of epileptics
with partial seizures who responded well to treatment, all SF-36 physical dimensions were
found to be normal whereas mental dimension scores were negatively affected<xref rid="r27" ref-type="bibr">27</xref><sup>)</sup>. In one study, men had lower scores for
physical functions than women<xref rid="r28" ref-type="bibr">28</xref><sup>)</sup>. The
selective negative impact of the disease on social dimensions of the patient QoL is probably
due to reported development of depressive symptoms in patients with epilepsy<xref rid="r29" ref-type="bibr">29</xref>, <xref rid="r30" ref-type="bibr">30</xref><sup>)</sup>. Still lower scores for women may be linked to recent findings of
higher incidence of depressive symptoms in female patients with epilepsy<xref rid="r31" ref-type="bibr">31</xref><sup>)</sup>.</p><p>The frequency of seizures consistently appeared to have an impact on QoL<xref rid="r28" ref-type="bibr">28</xref>, <xref rid="r32" ref-type="bibr">32</xref>,<xref rid="r33" ref-type="bibr">33</xref>,<xref rid="r34" ref-type="bibr">34</xref><sup>)</sup>.
Furthermore, seizure freedom was suggested to be necessary to improve QoL after epilepsy
surgery, but little is known regarding the seizure-frequency reduction needed to improve QoL
among medically treated individuals<xref rid="r23" ref-type="bibr">23</xref><sup>)</sup>.
The present study may help clarify the impact of response to treatment on QoL since subgroup
analysis supports the positive impact of good response to treatment on the QoL of epilepsy
patients. Indeed, the patients who responded well to treatment were aware of their improved
physical health as indicated by their significantly better SF-36 GH dimension and CH scores
while patients with a poor response had significantly lower scores in these dimensions.
Neither seizure type nor the the number of antiepileptic treatments had an effect on the
poor QoL in this latter group. Their mental health was also more affected than their
physical health while patients responding well to treatment had significantly better SF-36
mental dimension scores. Good response to treatment probably changes the patient’s opinion
about the disease while poor response and its unfavorable impact on social and occupational
life introduce more psychological burdens. Thus, the need for psychological support is
greater and should be recommended for the group with a poor treatment response; indeed, some
limited positive outcome of psychotherapy on the fatigue/vitality (VT) dimension has
recently been observed<xref rid="r29" ref-type="bibr">29</xref><sup>)</sup>.</p><p>Seizure severity was previously reported to be a significant predictor of QoL along with
depression but not the response to treatment<xref rid="r35" ref-type="bibr">35</xref><sup>)</sup>; this difference from the present work may originate from the use
of different scales or definitions for seizure freedom. It has also been claimed that
seizure-free adults can have QoL levels comparable to those of the general population<xref rid="r27" ref-type="bibr">27</xref><sup>)</sup>. This is not confirmed by our results
which show that although a significant improvement of QoL indices is observed concurrently
with good response to treatment, significant differences in the QoL as compared to that of a
healthy population were still preserved in social dimensions.</p><p>Interestingly, our results do not indicate that type of epilepsy, type of seizures, age at
onset, disease duration, work status, education level or treatment modality have an impact
on QoL. These findings contrast with those of previous studies which found longer disease
duration, advanced age, lower education level, use of polytherapy, presence of adverse
effects<xref rid="r36" ref-type="bibr">36</xref><sup>)</sup> and psychosocial factors<xref rid="r32" ref-type="bibr">32</xref><sup>)</sup> to be correlated with lower QoL.</p><p>Finally, this study points to mental health as the major burden in epilepsy and finds that
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