Assessing the psychosocial consequences of epilepsy: a community-based study

Background Few studies have measured, using validated scales, the psychosoc ial handicap of epilepsy in a general practice setting. Aim. To assess the prevalence of psychosocial problems associated with epil epsy. Method. A survey was undertaken of 309 subjects, with one or more non-febri le epileptic seizures, drawn from two general practices in the United Kingd om (UK). The outcome measures were the Subjective Handicap of Epilepsy Scal e (SHE), the SF-36, and the Hospital Anxiety and Depression scale (HAD). Results. One-third of persons with active epilepsy were significantly handi capped by their condition. The severity of subjective handicap was related to seizure frequency and to the duration of remission of seizures. Between one-third and one-half of subjects scored as 'cases' on the HAD scale and o n the mental health subscale of the SF-36. Only one-third of the psychiatri c morbidity revealed by the questionnaires had been recognized by the gener al practitioner (GP). Scores on the SF-36 indicated that people with active seizures perceived themselves as significantly less healthy than those in remission, and that, for persons in remission, drug treatment had a detrime ntal effect on certain aspects of well-being. Conclusions. The occurrence of seizures, even at low frequencies, is associ ated with psychosocial handicap, and this may remain covert in general prac tice.