Stigma and Polytherapy: Predictors of Quality of Life in Patients with Epilepsy from South India

Background: Apart from unpredictable seizures and consequent injuries, people with epilepsy (PWE) confront with psychosocial adjustments. Quality of life (QOL) varies with culture and socioeconomic milieu. Identification of predictors for QOL enables comprehensive and effective care. Objective: The objective of this study was to investigate the role of stigma, demographic, socioeconomic, and clinical factors in QOL among PWE. Subjects and Methods: In this prospective observational study, 170 PWE answered QOL in epilepsy-31 (QOLIE-31) and stigma questionnaire. Internal consistency of instruments was evaluated by Cronbach's alpha and reproducibility by intracorrelation coefficient (ICC). Descriptive statistics were calculated, and predictors were identified by regression analysis. Results: Mean age of the PWE was 34.39 +/- 11.49. Cronbach's alpha and ICC of the QOLIE-31 were 0.946 and 0.974 and stigma scale was 0.903 and 0.954, respectively. Mean total QOL was 60.29 +/- 14.12. Highest and lowest scores of subscales of QOL were observed in medication effects and social functioning. Mean stigma score of PWE was 22.21 +/- 14.64. Majority of PWE had mild stigma (75%) followed by moderate (22%) and high stigma (1%). Stigma score correlated with total and subscales of QOL (P < 0.01). Statistically significant decrease in scores of total and subscales of QOL was observed in high and moderate stigma when compared to mild stigma (P < 0.01). Stigma (standardized beta coefficient = -0.652, P < 0.00) and polytherapy (standardized beta coefficient = -0.180, P < 0.02) were found to be the significant predictors of QOL. Significant decrease in total and subscale scores of QOL was observed in PWE under polytherapy when compared to monotherapy and also in seizure frequent against seizure-free PWE (P < 0.01). Conclusions: Besides control of seizures, encouragement of monotherapy and destigmatization campaigns may improve the QOL of PWE.