QOLIE-31 Scores Research Articles

Prospective study of seizures in the elderly in the Marshfield Epidemiologic Study Area (MESA).

To assess the incidence, etiology, antiepileptic drug (AED) use, and quality of life in patients having their first seizure at age 50 years or older. All patients in the Marshfield Epidemiologic Study Area (MESA) aged 50 years or older having their first seizure between July 1, 1996, and June 30, 1998, were identified through the diagnostic coding system. Patients were followed up for 12 months for recurrent seizures. Etiologies, drug treatments, magnetic resonance imaging (MRI), computed tomography (CT), or EEG results and medication adverse effects were recorded. Those patients who reached 1-year follow-up received a quality of life (QOLIE-31) survey. Forty-eight patients having a first seizure were identified (162 of 100,000). Twelve patients had had recurrent seizures, and 36 had a single seizure at the time of study entry. Fourteen of these 36 had had an abnormal MRI, CT, or EEG. The remaining 22 had a single seizure and normal imaging and EEG. Six of these had one or more subsequent seizures, and all six were in the group with normal tests. Etiologies included vascular, neoplasm, trauma, dementia, metabolic, and unknown. Seventy-five percent of the patients achieved seizure control with phenytoin, carbamazepine, and/or valproate. Twenty-seven percent experienced adverse side effects. None had been given second-generation AEDs as an initial treatment. Thirty-one patients received the QOLIE-31 survey; 20 did not complete the survey for various reasons. The mean QOLIE-31 scores for those completing the survey were significantly higher than those of the reference cohort. The incidence of first seizure in MESA is high in the elderly and increases with advancing age. As in other studies, vascular causes accounted for the largest etiology. Use of new AEDs was uncommon. There was a high incidence of untoward side effects related to the traditional AEDs. High morbidity and mortality unrelated to seizures limits follow-up analysis in the elderly. Quality-of-life analysis via QOLIE questionnaires is problematic in this population.

Comparison between the QOLIE-31 and derived QOLIE-10 in a clinical trial of levetiracetam

Purpose: to determine whether the QOLIE-10, an abbreviated quality of life questionnaire, provides results similar to the more detailed QOLIE-31 instrument when the ten items are derived from the QOLIE-31. Methods: the QOLIE-31 was completed by 246 patients participating in UCB protocol N132 at baseline and after 18 weeks of treatment with levetiracetam (LEV 1000 or 3000 mg) or placebo added to standard therapy. QOLIE-10 components and total scores were calculated from the QOLIE-31 data. Results: baseline QOLIE-10 components and total score correlated highly with corresponding QOLIE-31 scores, both at baseline and follow-up (range 0.70–0.95). Changes from baseline to follow-up were significantly different (ANCOVA) among treatment groups for both the QOLIE-10 and QOLIE-31 for the total score ( P=0.02, P=0.009, respectively), seizure worry ( P=0.005, P=0.0003) and cognitive functioning ( P=0.01, P=0.01). One subscale (overall QOL) showed significant change with the QOLIE-31 ( P=0.04), but not with the QOLIE-10 ( P=0.07). Differences in QOLIE-10 scores were found between responders (≥50% partial onset seizure reduction) and non-responders for the total score ( P=0.0001) and two components (overall QOL P=0.002, social function P=0.0003). In the QOLIE-31, the total score and six subscale scores (all except medication effects) were significantly different. Both instruments were able to detect change over time. Responsiveness assessed by effect sizes (−0.1 for non-responders, 0.4 for responders, 0.8 for seizure-free patients) and the Guyatt statistic (−0.1, 0.6 and 1.0, respectively) was similar for both instruments. Conclusions: although the QOLIE-10 was designed as a screening tool, it can be scored and used in research. The total score did discern differences among treatments in a clinical trial. Nonetheless, questionnaires with multiple, multi-item subscales provide more detailed information than abbreviated forms. The QOLIE-31 is preferred where time and resources are available.