Effect of family factors on the prognosis of patients with epilepsy

Abstract

Objective To investigate the effect of family factors on the prognosis of patients with epilepsy and the relationship between family factors and clinical characteristics of epilepsy. Methods Data were collected from 107 patients definitely diagnosed with epilepsy who were treated by antiepileptic drugs for at least two years. All the patients were divided into good or poor prognosis group according to whether achieving at least one year free of seizures. The clinical and family data were collected. The questionnaire Family Adaptability and Cohesion Evaluation Scale-Ⅱ- Chinese Version containing 30 items was used for patients and the Epilepsy Knowledge Questionnaire containing 34 questions for primary caregiver. We compared the clinical and family factors between the two groups to identify the predictors of poor control of seizures with univariate and multiple Logistic regression, and observed the relationship between family factors and clinical features such as course, type of seizure, seizure frequency, etc, with Pearson correlation analysis. Results Patients with poor prognosis were more likely to have interictal epileptiform discharges(IEDs), multidrug treatment and pre-treatment seizure frequency of more than once monthly(84.6%(44/52) vs 50.9 %(28/55), χ2=13.797, P=0.000; 63.5%(33/52) vs 34.5%(19/55), χ2=8.947, P=0.003; 38.5%(20/52) vs 5.5%(3/55), χ2=17.257, P=0.000). Family in rural area, unbalanced family type, number of family members were much more in poor prognosis group than in good prognosis group(51.9%(27/52) vs 25.5%(14/55), χ2=7.923, P=0.005; 80.8%(42/52) vs 49.1%(27/55), χ2=11.712, P=0.000; 4.1±1.1 vs 3.6±0.8, t=2.631, P=0.010). And average family income, education level of father, the level of epilepsy knowledge of primary caregiver were significantly lower in poor prognosis group than in good prognosis group (19/20/13 vs 11/17/27, χ2=7.198, P=0.027; 15/30/7 vs 4/34/17, χ2=10.709, P=0.005; 36/11/5 vs 15/25/15, χ2=19.022, P=0.000). Multiple Logistic regression analysis demonstrated that IEDs (OR=12.332, 95% CI 2.756-55.190, P=0.001), pre-treatment seizure frequency of more than once monthly (OR=8.401, 95% CI 1.573-44.884, P=0.013) were clinical risk factors of unfavorable prognosis; more family members (OR=3.021, 95% CI 1.554-5.870, P=0.001), poor epilepsy knowledge of primary caregiver (OR=3.392, 95% CI 1.304-8.821, P=0.012) and unbalanced family type (OR=4.794, 95% CI 1.217-18.894, P=0.025) were independent family risk factors of poor prognosis. The level of epilepsy knowledge of primary caregiver was inversely associated with duration (r=-0.237, P=0.014). Conclusions The prognosis of epilepsy is not only affected by clinical factors, but also by family factors. More family members, poor epilepsy knowledge of primary caregiver and unbalanced family type are independent risk factors of unfavorable prognosis. The poorer epilepsy knowledge the primary caregivers have, the longer duration the disease has. Key words: Epilepsy; Family factors; Family relations; Prognosis