Factors predictive of resilience and vulnerability in new-onset epilepsy

Abstract

Purpose: Epilepsy has been associated with reduced quality of life (QOL), but QOL outcomes are heterogeneous. Some people are able to maintain a good QOL despite poorly controlled epilepsy and others report poor QOL despite well-controlled epilepsy. Maintaining a good QOL in the face of adversity is embodied by the concept of resilience. We explored the factors associated with having a resilient outcome in people with epilepsy (PWE). Our definition of adversity included socioeconomic disadvantage as well as continuing seizures.

Methods: We analyzed data collected as part of the Standard and New Antiepileptic Drugs (SANAD) trial. At the end of 4-year follow-up, patients were classified into four groups on the basis of seizure control (good/poor) and socioeconomic status (advantaged/disadvantaged). We identified individuals with resilient and vulnerable outcomes and the factors associated with having them.

Key findings: Seizure control was more important in determining QOL than material advantage, but socioeconomic status appeared to act as an additional protective or risk factor for QOL. Significant predictors of a resilient outcome were absence of depression and fewer adverse treatment effects at 4 years and good QOL at baseline. Significant predictors of a vulnerable outcome were fair/poor health perception, presence of depression, reduced sense of mastery, and more adverse treatment effects at follow-up.

Significance: Reducing the adverse effects of treatment, along with psychosocial interventions to increase self-mastery, reduce health concerns, treat depression, and promote positive adjustment to a diagnosis will likely improve the QOL of PWE despite less favorable clinical and socioeconomic circumstances.