Objective:

This systematic literature review (SLR) queries the existing literature to identify aspects associated with health-related quality of life (HRQoL) in PWFE, with an interest to evaluate modifiable determinants examined using multivariate methods.

Background:

Focal epilepsy (FE) can be a debilitating condition that negatively impacts a person’s HRQoL.  Several studies have been published on HRQoL in people with FE (PWFE) however the determinants of HRQoL have not been comprehensively examined.

Design/Methods:

The SLR was conducted in accordance with published guidelines..  Articles reporting on the association between HRQoL or employability and a range of demographic, psychosocial, or epilepsy-related factors and medical comorbidities in PWFE were identified.  N= 879 abstracts were screened (two independent reviewers), with N=25 studies identified leveraging multivariate methods.

Results:

Overall, the studies examined a broad range of determinant of HRQoL.  These included mood (depression, anxiety), epilepsy-related factors (seizure frequency, number of anti-seizure medications used, adverse event burden, disease duration, age of onset) and cognition.   Depression was the most frequently studied determinant, examined in N=14/25 studies and associated with lower HRQoL 86% of the time.  Anxiety was another frequently reported determinant, examined in 8 studies and significantly associated with lower HRQoL in 7 of them.  Employment was identified as an important consideration for HRQoL, with significance in all studies where it was examined (N=5).  Seizure burden was frequently examined (N=14/25 studies).  However only when dichotomized into seizure freedom vs experiencing seizures (by Engel class I vs II, III and IV) did it reach significance, notably every time (N=4 studies).  When seizure burden was examined as a continuous variable (N=10/25 studies) it was rarely significant (N=1 study).  The relationship between depression and HRQoL was overall the strongest among those assessed.

Conclusions:

Comprehensive understanding of modifiable determinants of HRQoL is relevant to patient health and well-being and can inform everyday clinical care, interventional and observational studies.