Fatigue and Depression in Epilepsy

BackgroundEpilepsy is a prevalent neurological disorder that can adversely affect multiple life domains, including mental health, sleep quality, and overall well-being. In Oman, where modern healthcare services have expanded substantially, limited data exist on how these factors influence the health-related quality of life (HRQoL) of adults with epilepsy. Accordingly, this study aimed to evaluate HRQoL and its relationships with depression, daytime sleepiness, and fatigue in Omani adults with epilepsy.MethodsA cross-sectional descriptive study was conducted among 238 Omani adults with epilepsy at two tertiary hospitals in Muscat. HRQoL was assessed using the Quality of Life in Epilepsy-31 (QOLIE-31), while depression, daytime sleepiness, and fatigue were measured via the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Epworth Daytime Sleepiness Scale (EDSS), and the Fatigue Severity Scale (FSS), respectively. Independent t-tests and one-way ANOVAs examined differences in QOLIE-31 scores, and Pearson correlations assessed relationships among the four scales. Continuous variables are reported as mean ± standard deviation (SD) and categorical variables as frequencies and percentages. Statistical analyses were two-tailed; results with p < .05 were considered significant.ResultsParticipants had a mean age of 32.74 years (SD = 11.77), and 55.5% were male. About 52.5% experienced generalized-onset tonic-clonic seizures, while 47.5% reported focal-onset seizures. Idiopathic epilepsy was common (50.8%), and half of the participants (50.4%) were on monotherapy. Regarding QOLIE-31 categories, 10.5% of participants had low HRQoL, 71.4% had moderate HRQoL, and 18.1% had high HRQoL. On the NDDIE, 34.9% screened positive for depression. Excessive daytime sleepiness (ESS ≥ 11) was observed in 11.3% of participants, and 54.6% reported clinically significant fatigue (FSS ≥ 36). Higher QOLIE-31 scores were associated with living in Muscat (p < .01), having a higher income (p < .01), being employed (p < .01), having idiopathic epilepsy (p < .05), and receiving monotherapy (p < .001). Depression, daytime sleepiness, and fatigue each showed a significant negative correlation with QOLIE-31 (p < .01).ConclusionsThis study highlights the multidimensional impact of epilepsy on Omani adults, demonstrating that clinical and socioeconomic factors—along with depression, sleepiness, and fatigue—significantly shape HRQoL. Targeted interventions aimed at seizure control, mental‑health support, and social empowerment are critical for optimizing well‑being in this population.

Equine-assisted therapy in quality of life and functioning of people with active epilepsy: A feasibility study

Patients with refractory epilepsy often have impaired quality of life (QOL) as a consequence of seizures and adverse effects of antiepileptic drugs. We assessed the impact of adverse effects on QOL and the utility of a structured instrument to help the physician manage adverse effects in patients with refractory epilepsy. Clinical characteristics, drug treatment and adverse effects were evaluated in 102 patients with refractory epilepsy at a single tertiary referral centre. The Adverse Events Profile (AEP) and Quality of Life in Epilepsy-31 (QOLIE-31) questionnaires were completed at baseline and after six months. At baseline, patients with a high burden of adverse effects (AEP scores ≥45) were randomized to an intervention or control group. AEP scores in the intervention group were available to the physician as an instrument to help to reduce adverse effects. Ninety-five patients (93.1%) were on polytherapy. Sixty-six completed the questionnaires and, of these, 43 (65.1%) had a high AE burden and were randomized to the intervention and control group. QOLIE-31 scores were inversely correlated with AEP scores at both visits. Among randomized patients, AEP scores tended to decrease between the baseline and the final visit without significant differences between groups (intervention group: 54.1 ± 6.1 vs 51.1 ± 9.1; control group: 55.8 ± 5.8 vs 50.5 ± 12.2). QOLI-31 scores did not change substantially between visits (intervention group: 45.9 ± 17.4 vs 48.4 ± 14; control group: 47.5 ± 15.7 vs 45.2 ± 18.9). A significant proportion of patients had a high toxicity burden which had an impact on their QOL. Reduction of overtreatment is a difficult challenge which cannot be addressed solely by providing a structured assessment of adverse effects, but requires a more comprehensive approach aimed at optimizing the many components of the management strategy.

ObjectiveTo determine the mean score of health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy.DesignInstitution-based cross-sectional study based on random case selection was conducted.SettingThe...

Quality of life in epilepsy

Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized/genetic epilepsy syndrome. Gender differences are known in clinical presentation, with a well-identified female predilection. We aimed to study gender-based differences in quality of life (QoL) and psychiatric comorbidities among persons with JME. This was a cross-sectional study conducted at a teaching hospital in Delhi, India. Persons above 11 years of age with JME diagnosed according to the International League Against Epilepsy criteria established in 2001 were enrolled. QoL assessment was made using Quality of Life in Epilepsy Inventory-Adolescents-48 (QOLIE-AD-48) and Patient-Weighted Quality of Life in Epilepsy Inventory 31 (QOLIE-31-P) for adolescent and adult patients, respectively. For the assessment of psychiatric comorbidities, participants were administered the Mini-International Neuropsychiatric Interview (M.I.N.I). Participants who tested positive for psychiatric comorbidities on M.I.N.I subsequently underwent the Diagnostic and Statistical Manual-5 categorization. We enrolled 50 patients with JME. Eighteen (36%) were male and 32 (64%) were female patients. The median age of males at study enrollment was 23.5 (range 15-38) years. The median age of females was 22 (16-48) years. The median QOLIE-31-P score among males was 68.31 (37.13-91.82) and for females was 66.9 (31.7-99.1). The median overall QoL score for males was 65 (25-87.5), which qualified as "fair" QoL. For females, the median overall QoL score was 62.5 (10-87.5) which also qualified as "fair" QoL. No significant difference was noted between genders in QoL (P = 0.723). Among males, 55.5% had psychiatric comorbidity. Of these, two had mild depression and eight had anxiety. Among female patients, 34.4% had comorbid psychiatric issues; 6 had anxiety and 5 had depression. No significant difference was noted between genders (P = 0.9136). Persons with JME do not have gender-stratified differences in terms of psychiatric comorbidities and QoL despite differences in exposure to antiseizure medications and other gender-related factors. All persons with JME should be screened for psychiatric comorbidities, specifically anxiety, and depression.

Drug-resistant or refractory epilepsy remains a significant clinical challenge, with persistent seizures and impaired quality of life, despite optimized antiepileptic therapy. Increasing attention has been directed toward adjunctive nutritional strategies that may support neuronal stability and overall well-being. The aim of the present study was to evaluate the real-world impact of Epregres Unique 12 as an adjunct to standard antiepileptic drug therapy on the quality of life and seizure frequency in patients with drug-resistant epilepsy. This prospective observational study was conducted at a tertiary care center between January 2023 and December 2024. Twenty-six patients with drug-resistant epilepsy were followed for 12 weeks after the initiation of adjunctive nutritional supplementation. Antiepileptic drug regimens were continued without protocol-driven modifications. The quality of life was assessed using the Quality of Life in Epilepsy-31 (QOLIE-31) questionnaire at baseline and after 12 weeks. Seizure frequency was documented by using patient-maintained seizure diaries. Data were analyzed using paired statistical tests with effect size estimation. Twenty-six patients (19 males, seven females; mean age 37.2 ± 7.4 years) were included. Emotional well-being showed a statistically significant improvement at 12 weeks (p = 0.009) with a moderate effect size. The total QOLIE-31 score demonstrated a clinically meaningful improvement, approaching statistical significance (p = 0.061). Seizure frequency decreased in 20 (76.9%) patients, including complete seizure cessation in 6 (23.1%) patients. The supplement was well-tolerated, with only one minor adverse event reported. Adjunctive nutritional supplementation is associated with improvements in emotional well-being and favorable trends in quality of life and seizure frequency in patients with drug-resistant epilepsy. While these findings are encouraging, controlled studies with larger sample sizes are required to confirm these observations.

Sleep disturbances, socioeconomic status, and seizure control as main predictors of quality of life in epilepsy

Quality of life in epilepsy in Bhutan

Knowledge, stigma, and quality of life in epilepsy: Results before and after a community-based epilepsy awareness program in rural Bolivia

The relationship of depression to antiepileptic drug adherence and quality of life in epilepsy

Objective:Many epilepsy syndromes are medically refractory, leading patients to be referred for surgical work-up to control their seizures and improve their quality of life (QOL). Although surgical treatments may reduce or stop seizures, many patients continue to present with declines in mood and/or cognition post-operatively. In addition, pre-operative QOL of patients with medically refractory epilepsy is impacted by executive function (EF). The present study aims to investigate the relationship between post-operative mood/QOL and pre-operative EF in adults with epilepsy. It was hypothesized that mood would remain stable or decline post-operatively; pre-operative EF would be a protective factor for mood decline and QOL.Participants and Methods:The sample consisted of 47 adult patients (57.4% female; Age, M= 34.02(11.59)) with medically refractory epilepsy at the UCSF Epilepsy Center. Participants were included if they received surgical treatment for their epilepsy (42.6% right anterior temporal lobectomy [ATL], 46.8% left ATL, 2.1% laser ablation, 6.4% responsive neurostimulation, 2.1% multiple surgical interventions) and received both a pre- and post-surgical neuropsychological evaluation. Most patients were right-handed (95.7% right). Mood and QOL were assessed from pre- and post-operative evaluations using the Beck Depression Inventory- Second Edition (BDI-II), Beck Anxiety Inventory (BAI), and Quality of Life in Epilepsy- 31 (QOLIE-31). Executive function was assessed using the Trail Making Test, and the Delis-Kaplan Executive Function Scale (D-KEFS) subtests Color-Word Interference (CW-I) and Verbal Fluency. Descriptive statistics were obtained for each of the measures listed. A paired sample t-test was conducted between time A and B to determine whether mood and QOL were significantly different. Two multiple regressions were conducted. One analysis for post-operative depression and QOL respectively with pre-operative EF.Results:At time A, both anxiety and depression were minimal (BDI M= 17.8, SD= 10.34; BAI M= 13; SD= 8.94). QOL was borderline clinically significant (QOLIE M= 37.46, SD= 9.74). Depression at time B was positively correlated with depression at time A (r[45]= 0.316, p=0.035). A paired sample t-test indicated that depression and QOL were significantly different at time A and time B (t[44]= 2.04, p= 0.047; t[31]= -3.34, p= 0.002), with improved scores post-operatively. Anxiety was not significantly different across time points (t[39]= 1.20, p=0.238). Multiple regression analyses indicated that pre-operative depression and EF did not predict post-operative depression (F(5,27)= 1.62, p= 0.189). Pre-operative EF (CW-I Inhibition-Switching), but not pre-operative depression, predicted post-operative QOL (F(4(24)= 3.13, p=.03, R2= .343).Conclusions:Results were somewhat discrepant from prior research in that depression and QOL improved post-surgically. Notably, while the observed change in depression was statistically significant it was not clinically significant according to literature (Doherty et al., 2021). Pre-surgical inhibitory control predicted QOL, illustrating that EF may serve as a protective factor post-surgically. The present study did not include a measure of seizure freedom classification post-operatively, therefore, future studies should investigate how seizure freedom classification impacts the relationship between mood, QOL, and cognitive outcomes.

ObjectiveTo investigate factors influencing somatic symptom disorder (SSD) in epilepsy patients and construct a cut-off point prediction model.MethodsUsing structured interviews and based on DSM-5 diagnostic criteria, the 206 epilepsy patients included in this study were categorized into SSD and non-SSD (n-SSD) groups. Demographic and clinical data were collected, and assessments were conducted using the Quality of Life in Epilepsy (QOLIE-31), Generalized Anxiety Disorder-7 (GAD-7), Neuropsychiatric Disease and Disability Inventory-Extended (NDDI-E), and Pittsburgh Sleep Quality Index (PSQI). Age, negative life events, seizure anxiety, energy/fatigue, GAD-7, NDDI-E, and PSQI scores were identified as independent risk factors for SSD comorbidity in epilepsy. The constructed cut-off model demonstrated good predictive performance. External validation in an independent multicenter cohort is required prior to clinical implementation.ResultsCompared with the n-SSD group, the SSD group exhibited statistically significant differences in age, age at onset, years of education, place of residence, number of comorbid physical illnesses, and adverse life events (all p < 0.05). The SSD group also showed significantly higher scores on GAD-7, NDDI-E, and PSQI, but lower total QOLIE-31 score and lower subscale scores for seizure worry, medication effects, energy/fatigue, life satisfaction, social functioning, and emotional well-being (all p < 0.05). Multivariate logistic regression analysis revealed that age (OR = 1.076, 95% CI: 1.015–1.141), negative life events(OR = 6.624, 95% CI: 2.130–20.606), seizure anxiety (OR = 0.945, 95% CI: 0.895–0.999), energy/fatigue (OR = 0.923, 95% CI: 0.872–0.977), and GAD-7 (OR = 1.274, 95% CI: 1.015–1.274) were independently associated with higher QOLIE-31 total scores. Fatigue (OR = 0.923, 95% CI: 0.872–0.977), GAD-7 (OR = 1.274, 95% CI: 1.037–1.565), NDDI-E (OR = 1.233, 95% CI: 1.038–1.442), and PSQI (OR = 1.375, 95% CI: 1.097–1.723) were independent predictors of SSD. The AUC of the nomogram model constructed based on the aforementioned factors was 0.939 (95% CI: 0.904–0.975), with an AUC of 0.907 following internal validation. The optimal risk probability cutoff value was 0.200 (based on the Yorden index), yielding a sensitivity of 84.7% and specificity of 95.3%. Calibration curve and decision curve analyses demonstrated good model calibration and clinical net benefit.ConclusionOlder age, exposure to negative life events, higher GAD-7, NDDI-E, and PSQI scores, and lower scores on the seizure worry and energy/fatigue dimensions of QOLIE-31 are independent risk factors for SSD in epilepsy patients. The constructed nomogram model demonstrates favorable predictive performance. External validation within an independent multicenter cohort is required prior to clinical implementation.

To assess (1) whether the generic Short Form (SF)-36, an integrated component of the epilepsy-targeted Quality of Life in Epilepsy Inventory-89 (QOLIE-89), is able to detect differences in the health-related quality of life (HRQOL) between young adults with epilepsy and healthy sibling controls and (2) whether the generic components are as sensitive to within-disease symptom severity as the epilepsy-targeted components of the QOLIE-89 in young adults with epilepsy. A cohort of young adults with epilepsy (N = 108, age 21.6 years SD = 3.8), followed since diagnosis in a prospective community-based study of childhood-onset epilepsy, completed the QOLIE-89, an epilepsy-targeted HRQOL instrument that includes within it a generic core measure (SF-36). Sibling controls (N = 82, age = 20.7 years, SD = 2.1) completed the generic core, SF-36. Age- and gender-adjusted QOLIE-89 epilepsy-targeted and cognitive-distress composite scores and the overall score were strongly associated with seizure-free duration: seizure-free ≥ 5 years (higher HRQOL), n = 57; seizure-free 1-5 years, n = 22; or seizure-free <1 year, n = 29 (lower HRQOL) (p < 0.001). However, on QOLIE-89 physical health and mental health composite scores, there were no differences across these seizure-free duration groups. For cases compared with sibling controls, there were no differences on SF-36 physical and mental health composite scores or the global composite score, using either classical test or item-response theory scoring procedures. While the epilepsy-targeted components of the QOLIE-89 are sensitive to seizure-related factors in young adults with epilepsy, the SF-36 generic core measures are not, thereby limiting HRQOL comparisons between young adults with epilepsy and sibling controls.

Vagus nerve stimulation (VNS) has emerged as a well-established therapeutic option for drug-resistant epilepsy (DRE). This study aims to assess treatment outcomes and prognostic factors in DRE patients undergoing VNS therapy. We conducted a single-center retrospective analysis of 44 consecutive DRE patients who underwent VNS implantation between 2017 and 2023. Primary efficacy endpoints were as follows: 1) absolute seizure reduction (SR) percentage and 2) responder rate (≥50% SR), evaluated during routine follow-up of 7 years. Secondary outcomes included safety, assessed through adverse event monitoring and quality of life in epilepsy-31, measured using standardized metrics. Multivariable logistic regression models were used to examine associations with 3 clinical predictors: gender, age at implantation, and preoperative epilepsy duration. The mean SR from baseline was 49.15%, with 21 patients (47.7%) meeting the responder criterion. Regression analysis identified a significant inverse relationship between epilepsy duration and treatment response (β = -0.1819, P = 0.0119 for age threshold 18; β = -0.1299, P = 0.0743 for age threshold 12). Device-related complications requiring surgical revision occurred in 2 cases (4.5%). Postoperative quality of life in epilepsy-31 scores averaged 59.95 (±14.35) on standardized assessments. Our findings demonstrate the sustained efficacy of VNS in managing DRE, with nearly half of the patients achieving clinically meaningful seizure control. The observed inverse association between disease duration and treatment response highlights the potential benefits of earlier VNS intervention. Together with its favorable safety profile, these results support the role of VNS as an integral component of comprehensive epilepsy management.