Insufficiently Controlled Epilepsy Reduces Quality and Length of Life
The effects of uncontrolled epilepsy far exceed the moment of a seizure, having a substantial impact on the psychological and physical well-being of patients. These individuals often sustain injuries during seizures, leading to reduced mobility, a higher risk of associated diseases, and premature death.
Refractory or Uncontrolled Epilepsy
Globally, more than 50 million people suffer from epilepsy. According to a large Western European population study, nearly a quarter of patients do not respond to treatment. These patients represent the greatest burden on the healthcare and social system. Patients with uncontrolled epilepsy have a higher frequency of comorbidities, psychological dysfunctions, social stigmatization, and a reduced quality of life with a decreased life expectancy.1
Premature Death
According to a systematic review from 2017, the risk of premature death in epileptics is approximately 1.6–3 times higher compared to the general population, and even 6.4–7.5 times higher in children. The risk is particularly high in patients with structural or metabolic epilepsy and in those with convulsive seizures. Patients who experience seizures despite treatment have a 9.3–13.4 times higher risk of death compared to those in remission.2
Impact of Seizure Frequency on Patient Health
It is believed that seizures are the primary cause of disability in people with epilepsy. The impact of seizure frequency on clinical outcomes was examined in a large population study by Canadian neurologists, utilizing data from the SLNCC registry (Survey of Living with Neurological Conditions in Canada). The registry included data from 713 epileptics (treated with antiepileptics or with a history of seizures in the last 5 years) with an average age of 45 years. The majority (95.7%) of patients were taking at least one antiepileptic. 42% had no seizures in the last 5 years and were considered to be in remission.3
Impact on Various Aspects of Life
Among 32% of patients with seizures, clinical depression symptoms were observed, reported by only 8% of patients in remission. After adjusting for age and gender, the likelihood of depression in patients with seizures was 6.4 times higher than in patients in remission.3
Patients with seizures had a 3 times higher probability of poor health status, a 4.5 times higher likelihood of being banned from driving, and a 2–3 times higher chance of limited education or professional opportunities, as well as social stigmatization compared to patients in remission.3
Conclusion
Insufficiently controlled epilepsy reduces the quality of life in many areas. Patients who achieved a 5-year seizure remission reported better health and psychosocial outcomes. Achieving complete control of the disease in all patients with epilepsy remains a primary goal.
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Sources:
1. Laxer K. D., Trinka E., Hirsch L. J. et al. The consequences of refractory epilepsy and its treatment. Epilepsy Behav 2014; 37: 59–70, doi: 10.1016/j.yebeh.2014.05.031.
2. Thurman D. J., Logroscino G., Beghi E. et al. The burden of premature mortality of epilepsy in high-income countries: a systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia 2017; 58 (1): 17–26, doi: 10.1111/epi.13604.
3. Josephson C. B., Patten S. B., Bulloch A. et al. The impact of seizures on epilepsy outcomes: a national, community-based survey. Epilepsia 2017; 58 (5): 764–771, doi: 10.1111/epi.13723.
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