Assessment of the Quality of Life of Young Men Suffering from Epilepsy

Voitiuk, A.^1* & Litovchenko, T.²

¹MD, Department of Neurology and Child Neurology, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
²PhD, Professor, Department of Neurology and Child Neurology, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine

*Correspondence to: Dr. Voitiuk, A., MD, Department of Neurology and Child Neurology, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine.

Copyright © 2019 Dr. Voitiuk, A., et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Epilepsy is one of the most frequent and serious neurological diseases. This disease ranks third among organic brain diseases.

According to the consensus of the International League against epilepsy (International League Against Epilepsy, ILAE) and International Bureau for epilepsy (International Bureau for Epilepsy, IBE), epilepsy is a disease of the brain defined by any of the following conditions:

1. At least two unprovoked (or reflex) seizures occurring >24h apart

2. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years

3. Diagnosis of an epilepsy syndrome.

According to the World Health Organization, about 50 million people worldwide suffer from epilepsy, 2.5 million new cases of the disease are diagnosed annually.

Recently, quite a lot of publications devoted to the problems of epilepsy in women. However, this disease affects not only women and children, but also men.

This disease has a significant negative impact on all areas of the patient’s functioning, reducing the quality of life. In everyday life, men with epilepsy regularly experience difficulties. Basically, it is a decrease in social and personal ambitions, low self-esteem compared to healthy people, an increase in the level of anxiety and depression. Depression in people with epilepsy is often manifested by symptoms that can be regarded as both side effects of AEDs, and as manifestations of epilepsy per se (sleep disorders, changes in appetite, behavioral disorders, inhibition or excessive excitability, etc.).

The purpose of the study is to assess the quality of life (QL) of young men aged 18-44 years with epilepsy, to determine the leading mechanisms of psychological protection and their effectiveness.

Methods
The study included neuropsychological testing using the Quality of Life in Epilepsy-31 questionnaire (Quality of life in epilepsy), the Hamilton scale for assessing the severity of depression (HDRS) and Columbia University suicide assessment scale (C-SSRS).

Results
Analysis of the test data of 40 patients (100%) showed that 6 (15%) of them rated their QL as “very low”. “Low” and “average” estimates of total QL were obtained from 10 (25%) and 16 (40%), respectively. In 8 (20%) patients, the parameters were located in the intervals of “good” QL.

No estimates of the “high” quality of life have been received in any case. On the HDRS scale, the severity of depressive disorder was determined in 24 patients (60%) as mild (7-17 points), moderate (18-24 points) - 14 patients (35%) and severe (>24 points) - 2 patients (5%).

Approximately one in nine men with epilepsy were diagnosed with major depressive disorder. Underdiagnosis of mental health issues, like depression, in men may be the result how men manifest symptoms. Various factors lead much men to exhibit depressive feelings through male-typical depressive symptoms. These symptoms can include aggression, irritability, violence, substance abuse, risky behavior, or somatic complaints. Since many male-typical symptoms of depression are externalized, they not only affect the wellbeing of depressed men but also the individuals in their lives. Depressed men are also less likely to demonstrate positive parental behaviors such as nurturing, warmth, sensitivity, and engagement, and more likely to be withdrawn, negative, and detached.

Early age epilepsy onset means a higher risk of suicide in men. A different pattern of variables was obtained for males, consisting mostly of values of daily doses of certain anti-epileptic drugs (AEDs), that is, phenobarbital PHB, carbamazepine CBZ, valproate VPA, clonazepam CNZ. A high daily dose of PHB and high total number of all seizures would imply a higher degree of suicidality. Besides men are four times as likely to die from suicide suggesting that much men have undiagnosed mental health issues.

Seizures aren’t the only concern for people with epilepsy. Many also struggle with a suicide risk caused by anti-seizure medications. Some epilepsy drugs might be more dangerous than others when it comes to suicide. The increased risk for suicide and self-harm comes only from newer drugs that are known to be associated with depression. These include levetiracetam, topiramate and vigabatrin. Older drugs and newer drugs that are not associated with depression did not increase the risk of suicide or self-harm, the study found. These drugs include lamotrigine, gabapentin, carbamazepine, valproate and phenytoin. People who were currently using the newer drugs with a high risk for depression were three times more likely to harm themselves or attempt suicide than those who were not taking any epilepsy drugs [1-5].

Conclusion
Thus, in patients with epilepsy revealed a significant decrease in QL, depending on the type of attack. Estimates of the “high” quality of life have not been obtained. Depression and anxiety disorders greatly affect the quality of life of patients, thus leading to an increase in the number of suicides. Men of all ages experiencing epilepsy are at increased risk for mental health issues, especially depression - and research has shown that about 20 percent of people with epilepsy attempt suicide at some point in life.

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