Determinantes de la calidad de vida en pacientes con epilepsia atendidos en dos instituciones hospitalarias de Colombia

Abstract

The world health organization defines the quality of life as an individual's perception of their position, expectations, and goals in life within the framework of their cultural context and value system. Due to the complexity and chronic course of epilepsy, people with this disease face several socioeconomic, physical, and psychological factors that significantly impact their quality of life. As a result, efforts have arisen to characterize the determinants of quality of life in epilepsy and to quantify them objectively; various screening questionnaires have been designed. The preceding has made it possible to address strategies to mitigate the most influential determinants. Background: at the local level, studies are scarce and limited to low-income populations and at the single-center level. Therefore, the interest arises in conducting a multicenter study, which seeks to characterize the specific determinants of the quality of life of Colombian people with epilepsy in a usual way, through standardized questionnaires, and in this way seek to direct the interventions toward the determinants that represent the most significant impact. Methodology: This is an observational, descriptive, cross-sectional study of patients diagnosed with epilepsy treated at the Fundación Santa Fe de Bogotá and the Fundación Valle del Lili from January 2022 to April 2022. The demographic and clinical characteristics, risk factors, scores on quality of life (QOLIE-10), anxiety (GAD-2), depression (PHQ-2), and side effects of medications (LAEP) were described. Results: sixty-five patients met inclusion criteria, completed the self-assessment instruments, and were included in the analysis. Fifty-three percent were female, and the mean age was 42.6 years (18-89 years). Approximately 47.7% had a job, and 58.5% had no driving license. The onset of the disease was at 26.6 years, and the mean seizure frequency was 19 seizures in the last three months. Epilepsy was focal in 86.2%. The etiology of epilepsy was structural in 46.2%. Nearly 66.1% received pharmacological polytherapy. Forty percent had refractory epilepsy. There were type A adverse effects in 50.8%. The QOLIE-10 overall score was 72.8 (range, 0-100), and 44.6% had a score  72.5. On the PHQ-2 scale, 20% had a score of  3. On the GAD-2 scale, 46.1% had a score  3. On the LAEP scale, the overall score was 39 (range, 19-63), and 32% had a score  45. The predictors of the overall QOLIE-10 score from the multiple linear regression analyses were having a depressive disorder ( = -0.284, p=0.003), seizure frequency in the last three months ( = -0.189, p=0.029) and the LAEP score ( = -0.513, p=<0.001). These variables explained 57% of the variance in the overall QOLIE-10 score. Conclusion: control of seizures is only one of the determinants of patients' quality of life with epilepsy. To improve the quality of care for epilepsy patients, evaluation of the quality of life and screening for depression, anxiety, and medication side effects are recommended. Interdisciplinary work with psychiatrists is essential to correctly diagnose and treat the comorbidities that frequently occur in patients with epilepsy.