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Quality of life outcomes of immediate or delayed treatment of early epilepsy and single seizures

From the Divisions of Public Health (A.J.) and Neurosciences (A.M., D.C.) and Centre for Medical Statistics and Health Evaluation (C.G.), University of Liverpool, Liverpool, UK; and Centre for Health Services Research (J.D.), University of Newcastle, UK.

Address correspondence and reprint requests to Dr. Ann Jacoby, Division of Public Health, University of Liverpool, Whelan Building, 3rd Floor, The Quadrangle, Liverpool L69 3GB, UK; e-mail: ajacoby{at}liv.ac.uk

Objective: To compare the impact of policies of immediate vs deferred treatment in patients with few or infrequent seizures on quality of life (QoL) outcomes.

Methods: We conducted a multicenter, randomized, unblinded study of immediate and deferred treatment. QoL data were collected by mail, using validated measures, for participants living in the UK and without major learning disability. Baseline questionnaires were returned by 441 adult patients; 333 returned 2-year follow-up questionnaires. This analysis is based on 331 patients (162 randomized to immediate, 169 to deferred treatment) returning both baseline and 2-year questionnaires.

Results: There were no significant differences at 2 years in QoL outcomes by treatment group. Patients randomized to deferred treatment were no more likely to report impairments in general health, cognitive function, psychological well-being, or social function. The one area of functioning affected was driving, where those randomized to deferred treatment were disadvantaged. There were clear QoL impacts both of taking antiepileptic drugs and, to an even greater extent, of continuing seizures.

Conclusions: In treatment uncertain patients, there is a clear trade-off between adverse effects of seizures and adverse effects of taking antiepileptic drugs, i.e., neither policy examined in our study was associated with overall quality of life gains or losses longer term.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the April 10 issue to find the title link for this article.

Editorial, see page 1172

*See appendix for membership.

The study was funded by the UK Medical Research Council.

The lead author (A.J.) had full access to all the data and had final responsibility for the decision to submit for publication. The funding source (UK MRC) had no role in study design, data analysis or interpretation, or writing of this manuscript.

Disclosure: The authors report no conflicts of interest.

Received February 21, 2006. Accepted in final form January 23, 2007.

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