Factors influencing quality of life in patients with temporal lobe epilepsy

Abstract

Background Temporal lobe epilepsy (TLE) predisposes individuals to cognitive difficulties and psychosocial consequences. Evaluating its impact on quality of life (QOL) is essential for patient care.

Objective To identify factors influencing QOL in low-income patients with TLE.

Methods An institution-based cross-sectional study was conducted on 40 patients with TLE during neurological consultations at a day clinic in Agadir, Morocco. The Quality of Life in Epilepsy Inventory-31 (QOLIE-31) was used to measure QOL. Multivariate linear regression analysis was performed to assess the associations between QOL and demographic, clinical, psychiatric, social, and cognitive variables. Results were considered statistically significant at a p-value < 0.05.

Results The mean overall QOL score was 48.14 ± 22.02. Among the seven scales of the QOLIE-31, the Seizure Worry scale had the lowest mean score. Cognitive function, social support, and self-esteem were positively associated with QOL. In contrast, memory complaints, seizure duration, seizure frequency, anxiety, and depression were negatively associated with QOL.

Conclusion While current interventions primarily target seizure control, our findings emphasize the need for holistic approaches that address both cognitive and psychosocial challenges to optimize QOL.

Keywords

Epilepsy, Temporal Lobe - Quality of Life - Cognition - Depression - Anxiety

Authors' Contributions

AT and NA: conceptualization and writing – review & editing; AT: data curation, formal analysis, investigation, methodology, software, and writing – original draft; NA: supervision, validation, and visualization.

Publication History

Received: 31 December 2023

Accepted: 29 September 2024

Article published online:
03 March 2025

• References

• 1 Giourou E, Stavropoulou-Deli A, Giannakopoulou A, Kostopoulos GK, Koutroumanidis M. Introduction to Epilepsy and Related Brain Disorders. In: Voros NS, Antonopoulos CP. , editors. Cyberphysical Systems for Epilepsy and Related Brain Disorders: Multi-parametric Monitoring and Analysis for Diagnosis and Optimal Disease Management [Internet]. Cham: Springer International Publishing; 2015. [cited 2023 Jul 4]. p. 11–38. Available from: https://doi.org/10.1007/978-3-319-20049-1_2
• 2 Maliki H, Alami M, Jilla M, Benbrahim F, Belahsen F, Zouhayr S. Évaluation de la qualité de vie chez les patients épileptiques par le QOLIE-31. Rev Neurol (Paris) 2018; 174: S23 Available from https://linkinghub.elsevier.com/retrieve/pii/S0035378718300882 cited 2023 Sep 8 [Internet]
• 3 Boling W, Means M, Fletcher A. Quality of Life and Stigma in Epilepsy, Perspectives from Selected Regions of Asia and Sub-Saharan Africa. Brain Sci 2018; 8 (04) 59 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924395/ cited 2023Oct6 [Internet]
• 4 Newton CR, Garcia HH. Epilepsy in poor regions of the world. Lancet 2012; 380 (9848) 1193-1201 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61381-6/fulltext cited 2023Oct19 [Internet]
• 5 Vinti V, Dell'Isola GB, Tascini G. et al. Temporal Lobe Epilepsy and Psychiatric Comorbidity. Front Neurol 2021; 12: 775781 https://www.frontiersin.org/articles/10.3389/fneur.2021.775781 cited 2022Dec6 [Internet]
• 6 Téllez-Zenteno JF, Hernández-Ronquillo L. A review of the epidemiology of temporal lobe epilepsy. Epilepsy Res Treat 2012; 2012: 630853
• 7 Bjørke AB, Østby Y, Grahl SG. et al. Cognition in adult patients with newly diagnosed non-lesional temporal lobe epilepsy. Epilepsy Behav 2021; 116: 107771 https://linkinghub.elsevier.com/retrieve/pii/S1525505021000056 cited 2022Dec16 [Internet]
• 8 Gauffin H, Landtblom AM, Vigren P. et al. Similar Profile and Magnitude of Cognitive Impairments in Focal and Generalized Epilepsy: A Pilot Study. Front Neurol 2022; 12: 746381 https://www.frontiersin.org/articles/10.3389/fneur.2021.746381/full cited 2023Jun3 [Internet]
• 9 Espinosa Jovel CA, Pardo CM, Moreno CM, Vergara J, Hedmont D, Sobrino Mejía FE. Demographic and social profile of epilepsy in a vulnerable low-income population in Bogotá, Colombia. Neurologia 2016; 31 (08) 528-534
• 10 Tedrus Gde AS, Fonseca LC, Carvalho RM. Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity. Arq Neuropsiquiatr 2013; 71 (06) 385-391 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28X2013000600385&lng=en&tlng=en cited 2021Oct8 [Internet]
• 11 Chen HF, Tsai YF, Hsi MS, Chen JC. Factors affecting quality of life in adults with epilepsy in Taiwan: A cross-sectional, correlational study. Epilepsy Behav 2016; 58: 26-32 https://linkinghub.elsevier.com/retrieve/pii/S1525505016000792 cited 2023May25 [Internet]
• 12 Ogundare T, Adebowale TO, Okonkwo OA. Quality of life among patients with epilepsy in Nigeria: predictors and barriers to routine clinical use of QOLIE-31. Qual Life Res 2021; 30 (02) 487-496 https://link.springer.com/10.1007/s11136-020-02643-x cited 2021Oct8 [Internet]
• 13 Addis B, Minyihun A, Aschalew AY. Health-related quality of life and associated factors among patients with epilepsy at the University of Gondar comprehensive specialized hospital, northwest Ethiopia. Qual Life Res 2021; 30 (03) 729-736 http://link.springer.com/10.1007/s11136-020-02666-4 cited 2021Oct8 [Internet]
• 14 Lozano-García A, Hampel KG, Villanueva V, González-Bono E, Cano-López I. The number of anti-seizure medications mediates the relationship between cognitive performance and quality of life in temporal lobe epilepsy. Epilepsy Behav 2021; 115: 107699 https://linkinghub.elsevier.com/retrieve/pii/S1525505020308799 cited 2022Dec16 [Internet]
• 15 Giovagnoli AR, Parente A, Tarallo A, Casazza M, Franceschetti S, Avanzini G. Self-rated and assessed cognitive functions in epilepsy: impact on quality of life. Epilepsy Res 2014; 108 (08) 1461-1468 https://linkinghub.elsevier.com/retrieve/pii/S0920121114001600 cited 2023May30 [Internet]
• 16 Alonso-Vanegas MA, Cisneros-Franco JM, Castillo-Montoya C, Martínez-Rosas AR, Gómez-Pérez ME, Rubio-Donnadieu F. Self-reported quality of life in pharmacoresistant temporal lobe epilepsy: correlation with clinical variables and memory evaluation. Epileptic Disord 2013; 15 (03) 263-271
• 17 Giménez DeGeorge E, Fullen C, Gess J, Kleiner J, Larson-Prior L. Effects of age of onset and medication on cognitive performance and quality of life in patients with epilepsy. Epilepsy Behav 2021; 121 (Pt A): 108008 https://linkinghub.elsevier.com/retrieve/pii/S1525505021002420 cited 2023Jun4 [Internet]
• 18 Saadi A, Patenaude B, Mateen FJ. Quality of life in epilepsy-31 inventory (QOLIE-31) scores: A global comparison. Epilepsy Behav 2016; 65: 13-17
• 19 Silva B, Canas-Simião H, Cordeiro S, Velosa A, Oliveira-Maia AJ, Barahona-Corrêa JB. Determinants of quality of life in patients with drug-resistant focal epilepsy. Epilepsy Behav 2019; 100 (Pt A): 106525 https://linkinghub.elsevier.com/retrieve/pii/S1525505019307966 cited 2021Oct8 [Internet]
• 20 Kissani N, Cherkaoui Rhazouani O, Souirti Z. et al. Epilepsy in Morocco: Realities, pitfalls and prospects. Epilepsia Open 2020; 6 (01) 13-21 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918313/ cited 2023Sep25 [Internet]
• 21 Benabdeljlil M, Azdad A. Mustapha E a. F. Standardization and validation of montreal cognitive assessment (MoCA) in the moroccan population. J Neurol Sci 2017; 381: 318 Available from https://www.jns-journal.com/article/S0022-510X(17)31398-9/abstract cited 2023 Sep 7 [Internet]
• 22 Nasreddine ZS, Phillips NA, Bédirian V. et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53 (04) 695-699
• 23 Pérez-Mojica D. A-42 Utility of the Montreal Cognitive Assessment (MoCA) Spanish Version in Detecting Cognitive Impairment in a Puerto Rican Temporal Lobe Epilepsy (TLE) Sample. Arch Clin Neuropsychol 2014; 29 (06) 518-519 cited 2023 Sep 7 [Internet]
• 24 Terkawi AS, Tsang S, AlKahtani GJ. et al. Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth 2017; 11 (Suppl. 01) S11-S18 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463562/ cited 2021Nov28 [Internet]
• 25 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (06) 361-370
• 26 de Oliveira GN, Lessa JMK, Gonçalves AP, Portela EJ, Sander JW, Teixeira AL. Screening for depression in people with epilepsy: comparative study among neurological disorders depression inventory for epilepsy (NDDI-E), hospital anxiety and depression scale depression subscale (HADS-D), and Beck depression inventory (BDI). Epilepsy Behav 2014; 34: 50-54
• 27 Rosenberg M. Society and the Adolescent Self-Image [Internet]. Princeton University Press; 1965 [cited 2023 Jul 4]. Available from: https://www.jstor.org/stable/j.ctt183pjjh
• 28 Badiaa EM, Belcaid K. Adaptation et validation arabe de l'échelle de l'estime de Soi de Rosenberg chez des adolescents collégiens marocains. Rev Adm Educ [Internet]. 2021 Oct 27 [cited 2023 Jun 1];(10):78–100. Available from: https://revues.imist.ma/index.php/READE/article/view/28771
• 29 Merrouni MA, Idrissi AJ, Lamkaddem A, Kava ACF, El Fakir S, Souirti Z. Moroccan Arabic version of the Quality of Life Inventory in Epilepsy (QOLIE-31): translation, cultural adaptation and psychometric validation. East Mediterr Health J 2021; 27 (03) 293-299 https://applications.emro.who.int/emhj/v27/03/1020-3397-2021-2703-293-299-eng.pdf cited 2022Dec16 [Internet]
• 30 Cramer JA, Perrine K, Devinsky O, Bryant-Comstock L, Meador K, Hermann B. Development and cross-cultural translations of a 31-item quality of life in epilepsy inventory. Epilepsia 1998; 39 (01) 81-88
• 31 Chen YY, Huang S, Wu WY. et al. Associated and predictive factors of quality of life in patients with temporal lobe epilepsy. Epilepsy Behav 2018; 86: 85-90
• 32 Gois J, Valente K, Vicentiis S. et al. Assessment of psychosocial adjustment in patients with temporal lobe epilepsy using a standard measure. Epilepsy Behav 2011; 20 (01) 89-94 https://linkinghub.elsevier.com/retrieve/pii/S1525505010007006 cited 2023Jun3 [Internet]
• 33 Johnstone B, Malpas CB, Velakoulis D, Kwan P, O'Brien TJ. Psychiatric symptoms are the strongest predictors of quality of life in patients with drug-resistant epilepsy or psychogenic nonepileptic seizures. Epilepsy Behav 2021; 117: 107861 https://linkinghub.elsevier.com/retrieve/pii/S1525505021000950 cited 2023Jun4 [Internet]
• 34 Pulsipher DT, Seidenberg M, Jones J, Hermann B. Quality of life and comorbid medical and psychiatric conditions in temporal lobe epilepsy. Epilepsy Behav 2006; 9 (03) 510-514 https://linkinghub.elsevier.com/retrieve/pii/S1525505006002824 cited 2023Jun3 [Internet]
• 35 Sancho J, Iváñez V, Molins A, López Gómez V, Masramón X, Pérez M. Changes in seizure severity and quality of life in patients with refractory partial epilepsy. Epilepsy Behav 2010; 19 (03) 409-413 https://linkinghub.elsevier.com/retrieve/pii/S1525505010005457 cited 2021Oct8 [Internet]
• 36 Ehrlich T, Reyes A, Paul BM. et al. Beyond depression: The impact of executive functioning on quality of life in patients with temporal lobe epilepsy. Epilepsy Res 2019; 149: 30-36 https://linkinghub.elsevier.com/retrieve/pii/S0920121118304005 cited 2023Jun4 [Internet]
• 37 Gauffin H, Landtblom AM, Räty L. Self-esteem and sense of coherence in young people with uncomplicated epilepsy: a 5-year follow-up. Epilepsy Behav 2010; 17 (04) 520-524
• 38 Hennion S, Szurhaj W, Skrobala E. et al. Experiences of self-conscious emotions in temporal lobe epilepsy. Epilepsy Behav 2019; 90: 1-6
• 39 McCagh J. Quality of Life Issues in Epilepsy. In: Holmes MD. , editor. Epilepsy Topics [Internet]. InTech; 2014 [cited 2023 Jan 4]. Available from: http://www.intechopen.com/books/epilepsy-topics/quality-of-life-issues-in-epilepsy
• 40 Tani A, Adali N. “The understanding and attitude toward epilepsy in the Souss-Massa region of Morocco”. Epilepsia Open 2023; 8 (02) 425-435
• 41 Kissani N, Moro M, Arib S. Knowledge, attitude and traditional practices towards epilepsy among relatives of PWE (patients with epilepsy) in Marrakesh, Morocco. Epilepsy Behav 2020; 111: 107257 https://linkinghub.elsevier.com/retrieve/pii/S1525505020304364 cited 2023Jun25 [Internet]
• 42 Meneses RF, Pais-Ribeiro JL, da Silva AM, Giovagnoli AR. Neuropsychological predictors of quality of life in focal epilepsy. Seizure 2009; 18 (05) 313-319 https://www.sciencedirect.com/science/article/pii/S1059131108002501 cited 2023Aug10 [Internet]
• 43 Rayner G, Siveges B, Allebone J, Pieters J, Wilson SJ. Contribution of autobiographic memory impairment to subjective memory complaints in focal epilepsy. Epilepsy Behav 2020; 102: 106636 https://www.sciencedirect.com/science/article/pii/S1525505019307942 cited 2023Aug10 [Internet]
• 44 Vaurio L, Karantzoulis S, Barr W. The Impact of Epilepsy on Quality of Life. In: Changes in the Brain: Impact on Daily Life. 2017. . p. 167–87.
• 45 Alkoblan FI, Alsoadan MM, Alhajri AA. et al. Social Anxiety, Social Support, and Quality of Life in Patients With Epilepsy at a Tertiary Care Hospital in Saudi Arabia. Cureus 2023; 15 (09) e45447 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10583124/ cited 2024Apr16 [Internet]
• 46 Pauli C, Thais Mde O, Claudino LS. et al. Predictors of quality of life in patients with refractory mesial temporal lobe epilepsy. Epilepsy Behav 2012; 25 (02) 208-213
• 47 Cano-López I, Hampel KG, Garcés M, Villanueva V, González-Bono E. Quality of life in drug-resistant epilepsy: relationships with negative affectivity, memory, somatic symptoms and social support. J Psychosom Res 2018; 114: 31-37 https://linkinghub.elsevier.com/retrieve/pii/S0022399918305865 cited 2021Oct8 [Internet]
• 48 Orjuela-Rojas JM, Martínez-Juárez IE, Ruiz-Chow A, Crail-Melendez D. Treatment of depression in patients with temporal lobe epilepsy: A pilot study of cognitive behavioral therapy vs. selective serotonin reuptake inhibitors. Epilepsy Behav 2015; 51: 176-181
• 49 Forthoffer N, Maillard L, Vignal JP, Tyvaert L, Jonas J, Brissart H. Remédiation cognitive de la mémoire en épilepsie: efficacité du programme COMETE (COgnitive Rehabilitation of MEmory in Temporal Epilepsy). Rev Neurol (Paris) 2022; 178: S61 . Available from https://www.sciencedirect.com/science/article/pii/S0035378722003071 cited 2023 Jun 7 [Internet]
• 50 Tsigebrhan R, Fekadu A, Medhin G, Newton CR, Prince MJ, Hanlon C. Comorbid mental disorders and quality of life of people with epilepsy attending primary health care clinics in rural Ethiopia. PLoS One 2021; 16 (01) e0238137