CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(09): 799-807
DOI: 10.1590/0004-282X-ANP-2020-0437
Article

Predictive factors of quality of life in temporal and extratemporal lobe epilepsy: association with affective temperament profiles and psychiatric comorbidities

Factores predictivos de la calidad de vida en la epilepsia del lóbulo temporal y extratemporal: asociación con perfiles de temperamento afectivo y comorbilidades psiquiátricas
1   Kocaeli Derince Education and Research Hospital, Department of Neurology, Kocaeli, Turkey.
,
2   Canakkale Onsekiz Mart University Medicine Faculty, Department of Psychiatry, Canakkale, Turkey.
› Author Affiliations

ABSTRACT

Background: Investigating predictive factors of reduced quality of life (QOL) of patients and their association with focal epilepsy can improve management and treatment strategies. Objective: This study aimed to investigate the relationship between affective temperaments, depression, anxiety, disease characteristics, and QOL and to explore the predictors of QOL in patients with temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). Methods: A total of 50 patients with TLE, 51 patients with ETLE, and 70 controls were enrolled. Affective temperaments were evaluated using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A). QOL was assessed by the Short-Form Health Survey (SF-36). Beck Depression Inventory and Beck Anxiety Inventory were used to explore depression and anxiety severity, respectively. Results: Compared with the controls, patients with TLE and ETLE had significantly higher scores on all TEMPS-A scales, except on hyperthymic temperament. All the SF-36 subscale scores were lower in the TLE and ETLE groups. Linear regression analysis revealed that depressive symptoms, anxiety, depressive and irritable temperament, and seizure frequency were significant predictors of QOL in TLE. Patients with ETLE with temperamental disturbances, depressive symptoms, and polytherapy had a poorer QOL. Conclusions: Affective temperaments, psychiatric disorders, and clinical factors may predict impaired QOL in patients with TLE and ETLE. Further studies are needed to identify predictors of QOL in various epilepsy subtypes.

RESUMEN

Antecedentes: Explorar los factores asociados y predictivos que reducen la calidad de vida en la epilepsia focal produce un efecto beneficioso en las estrategias de gestión y tratamiento. Objetivo: Investigar la relación entre temperamentos afectivos, depresión, ansiedad, características de la enfermedad y calidad de vida (QOL) y explorar los predictores de QOL en pacientes con epilepsia del lóbulo temporal (TLE) y epilepsia del lóbulo extratemporal (ETLE). Métodos: Se inscribieron un total de 50 pacientes con TLE, 51 pacientes con ETLE y 70 controles. Los temperamentos afectivos se evaluaron mediante el cuestionario de autoevaluación de Temperamento de Memphis, Pisa, París y San Diego (TEMPS-A). La calidad de vida se evaluó mediante la encuesta de salud de formato corto (SF-36). También se realizó a todos los participantes el Inventario de Depresión de Beck (BDI) y el Inventario de Ansiedad de Beck (BAI). Resultados: Los pacientes con TLE y ETLE tuvieron puntuaciones significativamente más altas en todas las escalas TEMPS-A que los controles, excepto la hipertimia . En la comparación de las puntuaciones del SF-36 dentro de cada grupo, todas las subescalas fueron más bajas en los pacientes con TLE y ETLE. El análisis de regresión lineal reveló que la depresión y la ansiedad, el temperamento depresivo e irritable y la frecuencia de las convulsiones fueron predictores significativos de la calidad de vida en el TLE. Además, los pacientes con ETLE con desequilibrios de temperamento afectivo, depresión comórbida y politerapia tenían una peor calidad de vida. Conclusiones: Los temperamentos afectivos, los trastornos psiquiátricos y los factores clínicos pueden predecir el deterioro de la calidad de vida en pacientes con TLE y ETLE. Se necesitan más estudios para descubrir los predictores de la calidad de vida en varios subtipos de epilepsia.

Authors’ contributions:

SB, HIT: conceived and designed the experiments; SB: analyzed the data; SB, HIT: contributed with reagents, materials, and analysis; SB: wrote the paper.




Publication History

Received: 24 September 2020

Accepted: 22 March 2021

Article published online:
01 June 2023

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  • References

  • 1 Sirven JI. Epilepsy: a spectrum disorder. Cold Spring Harb Perspect Med. 2015 Sep 1;5(9):a022848. https://doi.org/10.1101/cshperspect.a022848
  • 2 Hermann BP, Seidenberg M, Bell B. Psychiatric comorbidity in chronic epilepsy: identification, consequences, and treatment of major depression. Epilepsia. 2000 Feb;41 Suppl 2:S31-41. https://doi.org/10.1111/j.1528-1157.2000.tb01522.x
  • 3 Kanner AM. Mood disorder and epilepsy: a neurobiologic perspective of their relationship. Dialogues Clin Neurosci. 2008;10(1):39-45. https://doi.org/10.31887/DCNS.2008.10.1/amkanner
  • 4 Mula M, Sander JW. Psychosocial aspects of epilepsy: a wider approach. BJ Psych Open. 2016 Aug 17;2(4):270-4. https://doi.org/10.1192/bjpo.bp.115.002345
  • 5 Mahrer-Imhof R, Jaggi S, Bonomo A, Hediger H, Eggenschwiler P, Krämer G, et al. Quality of life in adult patients with epilepsy and their family members. Seizure. 2013 Mar 1;22(2):P128-35. https://doi.org/10.1016/j.seizure.2012.11.012
  • 6 Perini GI, Tosin C, Carraro C, Bernasconi G, Canevini MP, Canger R, et al. Interictal mood and personality disorders in temporal lobe epilepsy and juvenile myoclonic epilepsy. J Neurol Neurosurg Psychiatry. 1996 Dec 1;61(6):601-5. https://doi.org/10.1136/jnnp.61.6.601
  • 7 Kondziella D, Alvestad S, Vaaler A, Sonnewald U. Which clinical and experimental data link temporal lobe epilepsy with depression? J Neurochem. 2007 Dec;103(6):2136-52. https://doi.org/10.1111/j.1471-4159.2007.04926.x
  • 8 Swinkels WAM, van Emde Boas W, Kuyk J, van Dyck R, Spinhoven P. Interictal depression, anxiety, personality traits, and psychological dissociation in patients with temporal lobe epilepsy (TLE) and extra-TLE. Epilepsia. 2006 Dec;47(12):2092-103. https://doi.org/10.1111/j.1528-1167.2006.00808.x
  • 9 Akiskal KK, Akiskal HS. The theoretical underpinnings of affective temperaments: implications for evolutionary foundations of bipolar disorder and human nature. J Affect Disord. 2005 Mar;85(1-2):231-9. https://doi.org/10.1016/j.jad.2004.08.002
  • 10 Akiskal HS, Akiskal KK, Haykal RF, Manning JS, Connor PD. TEMPS-A: progress towards validation of a self-rated clinical version of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire. J Affect Disord. 2005 Mar;85(1-2):3-16. https://doi.org/10.1016/j.jad.2004.12.001
  • 11 Yazici E, Yazici AB, Aydin N, Orhan A, Kirkpinar I. Affective temperaments in epilepsy. Psychiatry Clin Psychopharmacol. 2012;22(3):254-61. https://doi.org/10.5455/bcp.20120731060406
  • 12 Taycan SE, Taycan O. Affective temperament profiles and clinical correlates in patients with epilepsy: a link from mood disorders. J Affect Disord. 2014 Aug;164:1-4. https://doi.org/10.1016/j.jad.2014.03.030
  • 13 Commission on classification and terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia. 1989 Aug;30(4):389-99. https://doi.org/10.1111/j.1528-1157.1989.tb05316.x
  • 14 Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961 Jun;4:561-71. https://doi.org/10.1001/archpsyc.1961.01710120031004
  • 15 Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988 Dec;56(6):893-7. https://doi.org/10.1037/0022-006X.56.6.893
  • 16 Ware Jr JE, Gandek B. Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. J Clin Epidemiol. 1998 Nov 1;51(11):P903-12. https://doi.org/10.1016/S0895-4356(98)00081-X
  • 17 Serafini G, Geoffroy PA, Aguglia A, Adavastro G, Canepa G, Pompili M, et al. Irritable temperament and lifetime psychotic symptoms as predictors of anxiety symptoms in bipolar disorder. Nord J Psychiatry. 2018 Jan;72(1):63-71. https://doi.org/10.1080/08039488.2017.1385851
  • 18 Sanchez-Gistau V, Pintor L, Sugranyes G, Baillés E, Carreño M, Donaire A, et al. Prevalence of interictal psychiatric disorders in patients with refractory temporal and extratemporal lobe epilepsy in Spain. A comparative study. Epilepsia. 2010 Jul 1;51(7):1309-13. https://doi.org/10.1111/j.1528-1167.2009.02464.x
  • 19 Rai D, Kerr MP, McManus S, Jordanova V, Lewis G, Brugha TS. Epilepsy and psychiatric comorbidity: a nationally representative population-based study. Epilepsia. 2012 Jun; 53(6):1095-103. https://doi.org/10.1111/j.1528-1167.2012.03500.x
  • 20 Kwon O-Y, Park S-P. Depression and anxiety in people with epilepsy. J Clin Neurol. 2014 Jul 3;10(3):175-88. https://doi.org/10.3988/jcn.2014.10.3.175
  • 21 Devinsky O, Barr WB, Vickrey BG, Berg AT, Bazil CW, Pacia SV, et al. Changes in depression and anxiety after resective surgery for epilepsy. Neurology. 2005 Dec 13;65(11):1744-9. https://doi.org/10.1212/01.wnl.0000187114.71524.c3
  • 22 Quiske A, Helmstaedter C, Lux S, Elger CE. Depression in patients with temporal lobe epilepsy is related to mesial temporal sclerosis. Epilepsy Res. 2000 Apr;39(2):121-5. https://doi.org/10.1016/S0920-1211(99)00117-5
  • 23 Kutlu A, Başaran S, Altun N, Unalan H, Komsuoğlu SS. Quality of life, depression and anxiety in patients with epilepsy: controlled study with Short Form 36 questionnaire, beck depression inventory and Hamilton Anxiety Scale. Neurosurg Q. 2010 Jun;20(2):95-9. https://doi.org/10.1097/wnq.0b013e3181dcb4ce
  • 24 Mutluay FK, Gunduz A, Tekeoglu A, Oguz S, Yeni SN. Health related quality of life in patients with epilepsy in Turkey. J Phys Ther Sci. 2016 Jan;28(1):240-5. https://doi.org/10.1589/jpts.28.240
  • 25 Tlusta E, Zarubova J, Simko J, Hojdikova H, Salek S, Vljek J. Clinical and demographic characteristics predicting QOL in patients with epilepsy in the Czech Republic: how this can influence practice. Seizure. 2009 Mar 1;18(2):P85-9. https://doi.org/10.1016/j.seizure.2008.06.006
  • 26 Taylor RS, Sander JW, Taylor RJ, Baker GA. Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review. Epilepsia. 2011 Dec;52(12):2168-80. https://doi.org/10.1111/j.1528-1167.2011.03213.x
  • 27 Kwan P, Yu E, Leung H, Leon T, Mychaskiw MA. Association of subjective anxiety, depression, and sleep disturbance with quality-of-life ratings in adults with epilepsy. Epilepsia. 2009 May 7;50(5):1059-66. https://doi.org/10.1111/j.1528-1167.2008.01938.x
  • 28 Milovanović M, Martinović Ž, Tošković O. Determinants of quality of life in people with epilepsy in Serbia. Epilepsy Behav. 2014 Feb 1;31:P160-6. https://doi.org/10.1016/j.yebeh.2013.12.015
  • 29 Yue L, Yu P-M, Zhao D-H, Wu D-y, Zhu G-X, Wu X-Y, et al. Determinants of quality of life in people with epilepsy and their gender differences. Epilepsy Behav. 2011 Dec 1;22(4):P692-6. https://doi.org/10.1016/j.yebeh.2011.08.022
  • 30 Melikyan E, Guekht A, Milchakova L, Lebedeva A, Bondareva I, Gusev E. Health related quality of life in Russian adults with epilepsy: the effect of socio-demographic and clinical factors. Epilepsy Behav. 2012 Dec 1;25(4):P670-5. https://doi.org/10.1016/j.yebeh.2012.09.042
  • 31 Lee S-J, Kim J-E, Seo J-G, Cho YW, Lee J-J, Moon H-J, et al. Predictors of quality of life and their interrelations in Korean people with epilepsy: a MEPSY study. Seizure. 2014 Oct;23(9):762-8. https://doi.org/10.1016/j.seizure.2014.06.007
  • 31 Lee S-J, Kim J-E, Seo J-G, Cho YW, Lee J-J, Moon H-J, et al. Predictors of quality of life and their interrelations in Korean people with epilepsy: a MEPSY study. Seizure. 2014 Oct 1;23(9):P762-8. https://doi.org/10.1016/j.seizure.2014.06.007
  • 33 Boylan L, Flint LA, Labovitz DL, Jackson SC, Starner K, Devinsky O. Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy. Neurology. 2004 Jan 27;62(2):258-61. https://doi.org/10.1212/01.WNL.0000103282.62353.85
  • 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 Nov 1;9(3):P510-4. https://doi.org/10.1016/j.yebeh.2006.07.014
  • 35 Chou C-C, Shih Y-H, Yen D-J, Kwan S-Y, Yu H-Y. Long-term health-related quality of life in drug-resistant temporal lobe epilepsy after anterior temporal lobectomy. Epileptic Disord. 2015 Jun;17(2):177-83. https://doi.org/10.1684/epd.2015.0744
  • 36 Dourado MV, Alonso NB, Martins HH, Oliveira ARC, Vancini RL, de Lima C, et al. Quality of life and the self-perception impact of epilepsy in three different epilepsy types. J Epilepsy Clin Neurophysiol. 2007 Dec;13(4):191-6. https://doi.org/10.1590/S1676-26492007000400009
  • 37 Ertem DH, Dirican AC, Aydın A, Baybas S, Sözmen V, Ozturk M, et al. Exploring psychiatric comorbidities and their effects on quality of life in patients with temporal lobe epilepsy and juvenile myoclonic epilepsy. Psychiatry Clin Neurosci. 2017 Apr;71(4):280-8. https://doi.org/10.1111/pcn.12499
  • 38 Chen Y-Y, Huang S, Wu W-Y, Liu C-R, Yang X-Y, Zhao H-T, et al. Associated and predictive factors of quality of life in patients with temporal lobe epilepsy. Epilepsy Behav. 2018 Sep 1;86:85-90. https://doi.org/10.1016/j.yebeh.2018.06.025
  • 39 Kalogjera-Sackellares D, Sackellares JC. Improvement in depression associated with partial epilepsy in patients treated with lamotrigine. Epilepsy Behav. 2002 Dec 1;3(6):P510-6. https://doi.org/10.1016/S1525-5050(02)00528-0
  • 40 First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV clinical version (SCID-I/CV). Washington (DC): American Psychiatric Press, Inc; 1996.