Acta Neurol Scand 2014: 130: 387–393 DOI: 10.1111/ane.12281
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd ACTA NEUROLOGICA SCANDINAVICA
Impact of somatic comorbidities on quality of life of patients living with epilepsy in Sagamu, Nigeria Adebayo PB, Akinyemi RO, Oluwole F, Ogun SA, Ogunniyi A. Impact of somatic comorbidities on quality of life of patients living with epilepsy in Sagamu, Nigeria. Acta Neurol Scand: 2014: 130: 387–393. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Purpose – Somatic comorbidities are probably as important as the psychiatry comorbidities in people with epilepsy (PWE) although the former has received little attention especially in low- and middleincome countries where the incidence of epilepsy is high. The main objective of this study was to determine the frequencies of somatic comorbidities in PWE. We also compared quality of life of two groups of PWE: Those with somatic comorbidities and those without. Methods – In this comparative cross-sectional study, consecutive adult patients with epilepsy above 18 years of age were recruited at the neurology outpatient clinic of Olabisi Onabanjo University Teaching Hospital from July 2010 through March 2011. Epilepsy-related data and somatic comorbidities were collated in this population. Health-related quality of life (HRQoL) and depression were also measured using QOLIE-31(version 1.0) and Becks depression inventory II (BDI-II), respectively. Results – One hundred and two PWE were recruited with 31 (30.4%) having at least one somatic comorbidity. Hypertension (OR = 12.43), dyspepsia (OR = 8.16), and stroke (OR = undefined) were significantly prevalent among PWE who are ≥50 years old. Energy was significantly lower among patients with comorbidities, and patients with multiple comorbidities had worse quality of life than those with single comorbidity (P = 0.006). Conclusion – Somatic comorbidity is prevalent in this population with significant impact on their quality of life. We emphasize the need to screen for and reduce the numbers of somatic comorbidities in PWE as this can improve their quality of life.
Introduction
Epilepsy is a common neurological condition especially in low- and middle-income countries (LMIC) where its incidence is higher when compared to high-income countries (1).The care of people with epilepsy (PWE) is often complicated by the need to manage concurrent psychosocial and/or somatic comorbidities and this is thought to contribute to the burden of epilepsy and its care (2). Psychosocial comorbidities of epilepsy have been well documented in Nigerians just like other sub-Saharan African societies (3–5). However, somatic comorbidities; although probably as
Philip B. Adebayo1,2, Rufus O. Akinyemi3, Folashade Oluwole1, Shamsideen A. Ogun1, Adesola Ogunniyi4 1 Neurology Unit, Department of Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria; 2Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola Univeristy/Ladoke Akintola University Teaching Hospital, Ogbomoso, Oyo-state, Nigeria; 3Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Ogun state, Nigeria; 4Neurology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo-State, Nigeria
Key words: comorbidity; epilepsy; Nigeria; quality of life; somatic P. B. Adebayo, Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, PMB 4000 Ogbomoso, Oyo-State, Nigeria Tel.: +2347033309010 e-mail: [email protected] Accepted for publication June 26, 2014
important, have not received as much attention (6) particularly in LMIC where nutritional and epidemiological transitions are occurring (7). In epilepsy, health-related quality of life (HRQOL) is adversely affected by any comorbidity as well as by seizure-related variables and anti-epileptic drug (AED) usage (8). The presence of somatic comorbidity has been demonstrated to negatively impact the quality of life of adults with epilepsy (9, 10) and this may be related to the number of medical comorbidities just as in other chronic conditions (11, 12). Understanding the interactions between epilepsy (and its treatment) and concurrent comorbidity is essential to 387
Adebayo et al. optimal patient management and improvement of their quality of life. This understanding should prevent the fragmentation of the care of PWE, ensuring that patients’ comorbidities are considered in the context of their epilepsy. Ultimately, the achievement of the key treatment goal (achievement of seizure control with optimal physical and cognitive functioning using the simplest AED regimen) (13) should be less tedious. The main aim of this study was to determine the frequency of somatic comorbidity and its impact on the HRQoL of PWE by comparing two groups of patients: those with somatic comorbidities and those without. We also screened this cohort for depressive symptomatology for the purposes of comparison between the two groups. Materials and methods
This prospective hospital-based comparative cross-sectional study was conducted among people living with epilepsy (PWE) who were evaluated in the neurology outpatient department of the Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, southwestern, Nigeria. This neurology outpatient service provides epilepsy care to residents of Ogun State (and adjoining states), Nigeria. Quality of life and depression were evaluated in PWE with and without somatic comorbidities between July 1, 2010 to March 31, 2011. Consecutive patients with age 18 years and above who were diagnosed as having epilepsy according to the definition and classification of ILAE (1981) (14) were included. Age
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd ACTA NEUROLOGICA SCANDINAVICA
Impact of somatic comorbidities on quality of life of patients living with epilepsy in Sagamu, Nigeria Adebayo PB, Akinyemi RO, Oluwole F, Ogun SA, Ogunniyi A. Impact of somatic comorbidities on quality of life of patients living with epilepsy in Sagamu, Nigeria. Acta Neurol Scand: 2014: 130: 387–393. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Purpose – Somatic comorbidities are probably as important as the psychiatry comorbidities in people with epilepsy (PWE) although the former has received little attention especially in low- and middleincome countries where the incidence of epilepsy is high. The main objective of this study was to determine the frequencies of somatic comorbidities in PWE. We also compared quality of life of two groups of PWE: Those with somatic comorbidities and those without. Methods – In this comparative cross-sectional study, consecutive adult patients with epilepsy above 18 years of age were recruited at the neurology outpatient clinic of Olabisi Onabanjo University Teaching Hospital from July 2010 through March 2011. Epilepsy-related data and somatic comorbidities were collated in this population. Health-related quality of life (HRQoL) and depression were also measured using QOLIE-31(version 1.0) and Becks depression inventory II (BDI-II), respectively. Results – One hundred and two PWE were recruited with 31 (30.4%) having at least one somatic comorbidity. Hypertension (OR = 12.43), dyspepsia (OR = 8.16), and stroke (OR = undefined) were significantly prevalent among PWE who are ≥50 years old. Energy was significantly lower among patients with comorbidities, and patients with multiple comorbidities had worse quality of life than those with single comorbidity (P = 0.006). Conclusion – Somatic comorbidity is prevalent in this population with significant impact on their quality of life. We emphasize the need to screen for and reduce the numbers of somatic comorbidities in PWE as this can improve their quality of life.
Introduction
Epilepsy is a common neurological condition especially in low- and middle-income countries (LMIC) where its incidence is higher when compared to high-income countries (1).The care of people with epilepsy (PWE) is often complicated by the need to manage concurrent psychosocial and/or somatic comorbidities and this is thought to contribute to the burden of epilepsy and its care (2). Psychosocial comorbidities of epilepsy have been well documented in Nigerians just like other sub-Saharan African societies (3–5). However, somatic comorbidities; although probably as
Philip B. Adebayo1,2, Rufus O. Akinyemi3, Folashade Oluwole1, Shamsideen A. Ogun1, Adesola Ogunniyi4 1 Neurology Unit, Department of Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria; 2Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola Univeristy/Ladoke Akintola University Teaching Hospital, Ogbomoso, Oyo-state, Nigeria; 3Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Ogun state, Nigeria; 4Neurology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo-State, Nigeria
Key words: comorbidity; epilepsy; Nigeria; quality of life; somatic P. B. Adebayo, Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, PMB 4000 Ogbomoso, Oyo-State, Nigeria Tel.: +2347033309010 e-mail: [email protected] Accepted for publication June 26, 2014
important, have not received as much attention (6) particularly in LMIC where nutritional and epidemiological transitions are occurring (7). In epilepsy, health-related quality of life (HRQOL) is adversely affected by any comorbidity as well as by seizure-related variables and anti-epileptic drug (AED) usage (8). The presence of somatic comorbidity has been demonstrated to negatively impact the quality of life of adults with epilepsy (9, 10) and this may be related to the number of medical comorbidities just as in other chronic conditions (11, 12). Understanding the interactions between epilepsy (and its treatment) and concurrent comorbidity is essential to 387
Adebayo et al. optimal patient management and improvement of their quality of life. This understanding should prevent the fragmentation of the care of PWE, ensuring that patients’ comorbidities are considered in the context of their epilepsy. Ultimately, the achievement of the key treatment goal (achievement of seizure control with optimal physical and cognitive functioning using the simplest AED regimen) (13) should be less tedious. The main aim of this study was to determine the frequency of somatic comorbidity and its impact on the HRQoL of PWE by comparing two groups of patients: those with somatic comorbidities and those without. We also screened this cohort for depressive symptomatology for the purposes of comparison between the two groups. Materials and methods
This prospective hospital-based comparative cross-sectional study was conducted among people living with epilepsy (PWE) who were evaluated in the neurology outpatient department of the Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, southwestern, Nigeria. This neurology outpatient service provides epilepsy care to residents of Ogun State (and adjoining states), Nigeria. Quality of life and depression were evaluated in PWE with and without somatic comorbidities between July 1, 2010 to March 31, 2011. Consecutive patients with age 18 years and above who were diagnosed as having epilepsy according to the definition and classification of ILAE (1981) (14) were included. Age
