Self-management practices associated with quality of life for adults with epilepsy

• Authors: Robert Quon, Dartmouth College; Angeline Andrew, Dartmouth College; Samantha Schmidt, Dartmouth College; Ngoc-Cam Escoffery, Emory University; Lindsay Schommer, Dartmouth College; Felicia Chu, University of Massachusetts; Heidi Henninger, Maine Medical Center; Keith Nagle, University of Vermont; Nicholas Streltzov, Dartmouth College; Barbara Jobst, Dartmouth College
• Journal Title: Journal of Neurology
• Volume: Volume 266, Number 11
• Publisher: Springer Heidelberg | 2019-11-01, Pages 2821-2828
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s00415-019-09503-w
• Subjects: Biology, Neuroscience; Health Sciences, Mental Health; Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Clinical Neurology; Neurosciences & Neurology; Epilepsy; Self-management; Quality of life; Depression; Determinants; Health; Depression; People; severity; Support; PHQ-9

Abstract

Epilepsy self-management practices enhance a patient’s competence and confidence in managing their chronic condition, which is assumed to lead to an improved quality of life (QoL). We analyzed the relationship between the Epilepsy Self-Management Scale (ESMS) responses and the Quality of Life in Epilepsy (QOLIE-31) scores. Baseline questionnaires from HOBSCOTCH, a self-management program for cognitive problems, were administered in four New England epilepsy centers on adults (n = 100) with epilepsy and subjective memory complaints. There was no correlation between overall self-management scores and overall quality-of-life scores; however, subscale analyses indicated that certain self-management practices were strongly correlated with the overall QOLIE-31 score. Specifically, improved ESMS lifestyle management was associated with an increased quality-of-life score (adjusted p < 0.01), while enhanced ESMS safety management practices were associated with a decreased overall quality-of-life score (adjusted p < 0.01). Our item-level analysis highlighted specific items within the ESMS safety management, ESMS lifestyle management, and ESMS information management subdomains that were significant predictors for QoL. Depression was also shown to be significantly correlated with the QOLIE-31 (p < 0.01). Our study suggests that an overemphasis on safety practices may negatively affect quality of life, while enhanced lifestyle management has positive effects. Furthermore, our finding that quality of life is greatly dependent on depressive symptoms underscores the importance of treating depression in epilepsy.