Factors predictive of resilience and vulnerability in new‐onset epilepsy

• Published in: Epilepsia (Copenhagen) Vol. 52; no. 3; pp. 610 - 618
• Main Authors: Taylor, Joanne, Jacoby, Ann, Baker, Gus A., Marson, Anthony G., Ring, Adele, Whitehead, Margaret
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-03-2011; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Anticonvulsants - economics; Anticonvulsants - therapeutic use; Anticonvulsants. Antiepileptics. Antiparkinson agents; Antiepileptic agents; Biological and medical sciences; Clinical trials; Cost-Benefit Analysis; Data processing; Depression; Drug Costs; Epilepsy; Epilepsy - drug therapy; Epilepsy - economics; Epilepsy - psychology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropharmacology; Perception; Pharmacology. Drug treatments; Prognosis; Quality of life; Quality of Life - psychology; Resilience; Resilience, Psychological; Risk Factors; Seizures; Sickness Impact Profile; Side effects; Socio-economic aspects; Socioeconomic Factors; Socioeconomic status; Surveys and Questionnaires; Young Adult; Nervous system diseases; Socioeconomic status; Epilepsy; Central nervous system disease; Vulnerability; Predictive factor; Cerebral disorder; Quality of life; Resilience
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/j.1528-1167.2010.02775.x

Summary
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.