Epilepsy is a life-altering brain disorder characterized by seizures and associated with a range of physical and psychiatric disorders. Roughly 50% of adults with epilepsy have at least one co-existing medical disorder. Moreover, the prevalence of several disorders, including depression and anxiety, are estimated to be eight times greater in individuals with epilepsy than those without epilepsy.
In addition to direct impacting health, co-existing conditions can become an immense financial burden for those with epilepsy. A study of adults with epilepsy using private health insurance in the United States showed that 80% of direct medical costs were not related to epilepsy, but rather for treatment costs for other co-existing conditions.
Epilepsy resulting from a traumatic brain injury (TBI), also known as posttraumatic epilepsy, is a unique circumstance which may worsen a patient’s quality of life, due to the additive negative effects of both conditions. This can be especially difficult for individuals who experience resistance to anti-seizure medications, a condition known as drug-resistant epilepsy. A recent study reported a higher incidence of drug resistance in post-traumatic epilepsy (45%) compared to people with non-traumatic epilepsy (33%), suggesting that those with post-traumatic epilepsy may face greater complications in the treatment process and require more rigorous interventions.
Posttraumatic epilepsy can significantly alter individuals’ quality of life, but many of the risk factors go largely unnoticed. One research study found that a significant portion of veterans with epilepsy had an undocumented TBI, despite having no evidence of a TBI in their medical records. This discrepancy leaves many individuals vulnerable to inadequate medical attention. Being aware of the following risks in those with post-traumatic epilepsy can assist both patients and clinicians with making informed medical decisions and navigating the challenging progression of epilepsy.
What are the risk factors for low quality of life with epilepsy?
- History of traumatic brain injury. Epilepsy and additional co-existing conditions have been associated with reduced quality of life for those with mild and severe traumatic brain injuries. Individuals across the spectrum of TBI severity should be aware of the risk for additional health concerns and take proper screening precautions, regardless of the nature of TBI.
- Drug-resistant epilepsy. Survey-based research showed that people with post-traumatic epilepsy who are resistant to anti-seizure medications scored lower on quality of life assessments and reported higher levels of impairment than those without drug resistance. Poor quality of life may be attributed to other difficulties associated with drug-resistant epilepsy, including physical injury, cognitive impairment, and psychiatric symptoms.
- Co-existing psychiatric conditions. Psychiatric conditions, such as depression, can make daily social interactions more challenging, and are common among people with post-traumatic epilepsy. Psychological disorders can ultimately contribute to quality of life concerns, including unemployment and functional losses for individuals with epilepsy.
Why is it important to know the risk factors?
- Early detection and early intervention of co-existing conditions. The time of detection for epilepsy co-existing conditions is a fundamental to quality of life and disease development. In clinical research, there is increasing evidence to suggest that treating co-existing conditions can also promote seizure control in epileptic patients, potentially reducing drug resistance. The sooner a comorbid condition is detected, the earlier and more effectively treatment can prevent further complications.
- Taking action to improve quality of life. While screening protocols for many common diseases are available to the general population, epilepsy-specific guidelines for detecting co-existing conditions are limited. By expanding screenings, co-existing conditions in individuals with epilepsy can be recognized and treated earlier.
References:
Gugger J, Kennedy E, Panahi S, et al. Multimodal Quality of Life Assessment in Post-9/11
Veterans With Epilepsy. American Academy of Neurology. (January 2022).
Pugh M, Kennedy E, Gugger J, et al. The Military Injuries: Understanding Post-Traumatic Epilepsy Study: Understanding Relationships among Lifetime Traumatic Brain Injury History, Epilepsy, and Quality of Life. Journal of Neurotrauma. (October 2021).
Keezer M, Sisodiya S, Sander J. Comorbidities of epilepsy: current concepts and future perspectives. Lancet Neurology. (November 2015).