Determinants of quality of life in Nigerian female patients with epilepsy on carbamazepine and levetiracetam monotherapy
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery volume 59, Article number: 32 (2023)
The study is aimed to identify the predictors of Quality of Life (QOL) in women with epilepsy (WWE) on carbamazepine (CBM) and levetiracetam (LTM) monotherapy. 100 WWE were recruited (50 each on CBM and LTM), after clinical diagnosis of epilepsy supported by Electroencephalography (EEG) features and seizures classification by 2017 International League Against Epilepsy (ILAE) criteria, the Quality of Life Inventory Scale 31(QOLIE-31) and Zung Self-Rating Depression Scale (ZSRDS) were used to assess QOL and depression, respectively.
Higher QOLIE-31 scores was seen in the LTM group across all domains except seizure worry (p = 0.051) compared to CBM group. Logistic regression showed that the use of CBM (p = 0.000), fast frequency on EEG (p = 0.005), longer duration of epilepsy (p = 0.017), presence of depression (p = 0.008) and lower level of education (p = 0.003) were predictors of QOL. Progesterone (p = 0.040), oestradiol (p = 0.011) and prolactin (p = 0.002) in follicular phase showed significant association with QOLIE-total score. In the luteal phase, luteinizing hormone–follicle stimulating hormone (LH–FSH) ratio (p = 0.009) and testosterone (p = 0.015), FSH (p = 0.015), prolactin (p = 0.000), showed significant association with QOL. None of the hormones independently predicts QOL.
LTM group appears to have better QOL than CBM group. Healthcare providers should focus on addressing these identified predictors which include medication effect, depression, Level of education, EEG background and duration of epilepsy with aim of improving QOL.
People living with epilepsy experiences social consequences, cognitive impairment, mental health conditions and poor Quality of Life (QOL) [1, 2]. The QOL has been described as pragmatic end point in the management of people living with epilepsy [3, 4]. Seizure frequency, seizure severity, level of education, depression, polytherapy and adverse events profile are major determinants of QOL in Patients with Epilepsy (PWE). In addition, women with epilepsy (WWE) faces unique challenges throughout their lifespan owing to the interplay between seizures, anti-epileptic drugs (AEDs) and sex steroid hormones . This tri-directional complex relationship results in the disruption of the hypothalamic pituitary ovarian axis which affects the determinants of QOL like seizure frequency, depression and adverse events profile in WWE [6, 7]. In a cross-sectional study to evaluate the use of AEDs patterns and their impacts on QOL among 200 patients, there were more cases of adverse drug reaction among those on polytherapy compared to those on monotherapy and the study concluded that selection of rational and safer AED treatment options plays a major role in achieving better QOL in patients with epilepsy . However, previous studies had shown that positive effects of newer AEDs like levetiracetam (LTM) as add-on therapy on QOL but just few studies have been able to look into the actions of LTM as a sole agent on QOL of PWE . Furthermore previous studies have linked AEDs especially those that interfere with cytochrome P450 to reproductive endocrine with alteration of the level of circulating gonadotropins and sex steroid hormones [5, 10]. These changes have attending effects on seizures control and frequency which are some of the major determinants of QOL especially in WWE. Previous studies have evaluated the effect of CBM as monotherapy on sex steroid hormones and its effect on QOL, but there are few data on effect of LTM as monotherapy on sex steroid hormones and attending effect on overall QOL in our environment and sub-Saharan African (SSA) by extension. This study aims to identify the predictors and compare QOL in WWE on carbamazepine (CBM) and LTM monotherapy.
This is a medical out-patient hospital-based cross-sectional study between August 2015 to August 2016. A total of 100 age-matched WWE of reproductive age group with 50 each on CBM and LTM monotherapy were randomly selected from available records in the clinic which serve as sampling frame. We excluded WWE that were currently or previously on any other AEDs apart from CBM or LTM, and those with any form of endocrinopathies, mental health issues and primary/secondary amenorrhea. The choice of CBM, was driven by the fact that it is mostly prescribed/used of the first-generation AEDs but limited by significant drug interaction and induction hepatic microsomal enzyme [11, 12]. While LTM is a newer generation drug with increasing usage, lesser drug interaction and effect on hepatic microsomal enzyme . The participants on CBM were 200 mg of twice daily, while those on LTM were on 250 mg twice daily. Sample size was calculated using the formula for comparison of means average and standard deviation of Quality of Life Inventory Scale 31(QOLIE-31) among WWE from previous studies was used . However, because of the non-parametric distribution of variables and the availability of small data set bootstrapping re-sampling was done. Participants for this study were fully informed on the research protocol detailing the purpose, method, risks, and benefits of the research. The risk concerning adverse reaction related to CBM and LTM, pain from blood sampling withdrawal, possible reaction to contrast during neuroimaging, and possible allergy with gel used during attachment of Electroencephalography (EEG) electrode were explained to the patients. A Phoenix digital 32-channel EEG machine made in Austria was used. Each of the participant gave a written and well understood informed consent. The consent was translated to the local language for those who did not understand English language and the services of interpreters were employed. Participants were free to decline participation or withdraw from the study at any time without reprisal or loss of benefit. After clinical diagnosis of epilepsy, seizure classification and definition of epileptiform activity on EEG were in accordance with International League Against Epilepsy (ILAE) and Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology by two different Neurologists [14,15,16,17,18]. An interviewer based pre-established questionnaire was used to obtain clinical information with regard to socio-demographic characteristics and medical history related to epilepsy of interest which include age of onset, aetiology, duration of epilepsy, frequency and types of AED used . We used QOLIE-31, an instrument previously validated in clinical studies among Nigerian cohort to assess the QOL [13, 20]. The QOLIE-31 has good psychometric properties with test–retest reliability ranging from (0.64–0.85) and internal consistency reliability co-efficient ranging from α = 0.77 to α = 0.85 for social functioning scale and cognitive functioning scale, respectively [3, 4, 13]. The instrument measures QOL by conversion of preceded numeric value from raw data to a scale of 0 to 100 with higher scores indicating a better QOL and places emphasize on seven domain which includes seizure worry, emotional well-being, energy/fatigue, medication effects, cognitive functioning, social functioning and overall quality of life . The Zung Self-Rating Depression Scale (ZSRDS) was used to screen for depression [21, 22]. It consist of a 20 item with Likert-type scale after each item and the score for each of item ranges from 1 to 4. The minimum possible score is 20 and 80 is the maximum possible score. A score > 50 is taken as depression [22, 23]. Hormonal sample collection, handling analysis and menstrual characteristics was as we previously described . Catamenial epilepsy as a twofold increase in daily seizure frequency during specific phases of the menstrual cycle [25,26,27]. The Statistical Package for Social Science for windows version 22 acquired by IBM in 2013 and manufactured in Armonk, New York, was used for analysis of the data obtained after initial entering and cleaning on Microsoft Excel. The Shapiro–Wilk test was used to check for normality of data and the significant value was greater than 0.05 for all the test thus making the data a normal distribution. Socio-demographic characteristics was tested using Chi-square statistics while the association between the socio-demographic characteristics and QOLIE-31 score were tested using the independent Student’s t-test and one-way analysis of variance (ANOVA) with a post hoc test using Tukey's honest significance test. The Tukey's honest was used to find means of the correlates (socio-demographic and clinical variables) that are significantly different from each other. A multiple linear regression model was used to assess the independent predictors of the QOLIE-31 total score. A level of statistical significance was set at p-value of less than 0.05 for all statistical analysis.
Table 1 shows that the mean age of patients was 29.07 ± 7.55, while the mean age of onset was (20.01 ± 11.57). The largest percentage of participants had secondary education and a total of 14% had depression. Furthermore, the duration of epilepsy was more than 2 years in 77% and less than 2 years in 23% among WWE. Considering, QOLIE 31 total score, the mean score was statistically significantly higher among WWE that have postgraduate education, use of LTM, epilepsy duration of < 2 years, slow background frequency on EEG and those without depression. With regard to menstrual history, both groups had comparable age of menarche and presence of catamenial epilepsy; p-value: p (0.094, 0.092), respectively. A higher number of the LTC group had hirsutism, 10 (20.0%), inter-menstrual bleeding, 9 (18.0%), dysmenorrhea 40 (80.0) and dyspareunia, 13 (26.0%) as opposed to the CZP group (see Table 2).
Table 3 shows that the mean total score of QOLIE-31 was 49.69 ± 13.45, with the highest seen in overall QOL domain 54.56 ± 21.64 and lowest in cognitive functioning domain 46.98 ± 15.98. Higher scores was seen in LTM group with statistically significant differences across all domains except seizure worry (p = 0.051). The level of education is associated with seizure worry (p = 0.020), overall QOL (p = 0.002), energy (p = 0.032), cognitive functioning (p = 0.000) and social functioning (p = 0.001). Depression is associated with overall QOL (p = 0.009), energy (p = 0.022), cognitive functioning (p = 0.016), medication effects (p = 0.009), and social functioning (p = 0.013).
There is an association between duration of epilepsy and overall QOL (p = 0.005), medication effects (p = 0.019) and social functioning (p = 0.015). Family history of epilepsy is associated with seizure worry (p = 0.022) and cognitive functioning (p = 0.038). There is no significant association between last episode of seizure and epileptiform pattern with domains of cognition except for emotional well-being (p = 0.005, p = 0.028, respectively). There is significant association between types of AED and domains for cognition except for seizure worry (p = 0.051). EEG frequency is associated with overall QOL (p = 0.004), emotional well-being (p = 0.001), cognitive functioning (p = 0.009) and medication effects (p = 0.023) (see Table 4).
Logistic regression analysis showed that the medication (p = 0.000), EEG frequency (p = 0.005), duration of epilepsy (p = 0.017), depression (p = 0.008) and level of education (p = 0.003) were significant predictors of poor QOL (see Table 5).
As shown in Table 6, there was a significant correlation between prolactin and all the domains of QOLIE-31 in both follicular and luteal phase. Progesterone (p = 0.040), oestradiol (p = 0.011) and prolactin (p = 0.002) in the follicular phase showed a statistically association with QOLIE-total score. While FSH (p = 0.015), prolactin (p = 0.000), LH-FSH ratio (p = 0.009) in the luteal phase and testosterone (p = 0.015) showed a significant association. However, none of the hormones independently predict the quality of life on linear regression analysis (see Table 7).
To the best of our knowledge, this is one of the very few studies aimed at identifying determinants of QOL in WWE. Identified predictors of poorer QOL in WWE from this study include medication effects, educational level, depression, background EEG frequency and duration of epilepsy. The level of education has been a consistent indicator found to be associated significantly with QOL [13, 28,29,30], thus it was not surprising that this study demonstrated that low QOLIE-31 total score was seen among people who had little formal education and higher among those with postgraduate education. Education is an important indicator that may directly or indirectly influence QOL through its association with employment, higher social class, and economic status. The role of education in ensuring medication adherence should not be underestimated [13, 30, 31]. Clearly the choice of anticonvulsants plays a significant role in the determination of the QOL in epilepsy . Previous studies have demonstrated an improvement in QOL with use of LTM as add-on therapy. In this present study, LTM performed better than CBM across all domains of QOL except seizure worry. These findings from our study is similar to findings from another study by Rudakova and colleagues, on effect of current AEDs on quality of life of PWE which concluded that patients treated with LTM had higher scores than patients treated with CBM . Studies in the past have evaluated impact of newer drugs on QOL in PWE using various tools such as SF-36, QOLA, QOLIE-89 and QOLIE-31 in variety of clinical settings and have consistently demonstrated an improvement in QOL [4, 29, 32]. On the other hand, unsatisfactory effect of CBM on QOL has been attributed to the unfavourable pharmacokinetic profile and adverse drug reaction [12, 32]. However, it will be difficult to ascribe causality and temporal relationship to sole effect of medications because the cross-sectional nature of the study design. A prospective randomised control trial or longitudinal study will be needed to deduce such causal relationship between LTM/CBM and QOL. It is rather surprising that we are unable to demonstrate any association between seizure type and QOL as it was previously demonstrated though with contrasting finding from different studies, while Herodes and colleagues reported lower scores in patients with generalized tonic–clonic seizures, Thomas and colleagues among Indian and Guekht and colleagues in Russian patients demonstrated that focal seizures had lower QOL scores than those with generalized seizures [33, 34]. A plausible reason for this difference are varied duration of seizures and gender specificity in our cohort. Another predictor of QOL identified in this study was the presence of fast frequency background on EEG. The EEG have proven to be a reliable biomarker that helps in detecting cortical abnormalities associated with cognitive decline, an important component of QOLIE-31  . There was a significant association between hormones and QOLIE-31 total score, but this did not attain any significant level on regression model. We thus suggest further evaluation of this potential therapeutic implication of this finding using a larger sample size in longitudinal study. The interplay between the sex steroid hormonal, epilepsy, and AED is complex. Both interictal and ictal discharges have been proposed as altering the sex steroid hormonal axis at the level of the hypothalamus and the pituitary [26, 27]. There is large variability in reported cases due to differing definitions, however, work by Herzog and colleagues has led to a more uniform acceptance of the definition of CE as a twofold increase in daily seizure frequency during specific phases of the menstrual cycle [25,26,27]. This study reported a CE frequency of 6% with no significant difference in both groups. Progesterone has long been shown in several studies to have anti-seizure activities . WWE are prone to seizure in response to decrease level of progesterone especially during premenstrual period . The main anti-seizure effect of progesterone has been linked to its conversion to all pregnanolone, an intermediate precursor, which has positive modulatory effect on GABA-A receptors . Also, progesterone may modulate signalling cascades of inflammation, apoptosis, neurogenesis, and synaptic plasticity and therefore, progesterone may directly exact disease-modifying effects on epileptogenesis [27, 37, 38]. Thus, enhancing the activity of progesterone or its derivatives might be an unexplored therapeutic end point in reducing seizures and improving QOLIE-31 in WWE. Oestrogen is generally believed to have proconvulsant and epileptogenic property in animals and humans . However, some other studies have shown that the effect of oestrogen on seizure susceptibility is highly variable depending on the factors such as treatment duration, dosage, hormonal status and seizure model . Harden and colleagues reported a positive correlation between seizure and the oestrogen–progesterone ratio in WWE picking in the premenstrual and pre-ovulatory period and declining during the mid-luteal phase . The effect of testosterone on seizure is complex and metabolites dependent, while the aromatization metabolite 17beta oestradiol has proconvulsant effect, testosterone on other hand is converted by 5 alpha reductase to 5 alpha dihydrotestosterone and then subsequently to 3 alpha androstenediol which has anticonvulsant property through its GABA modulating effect . Findings from our study was also in keeping with previous findings that depression is a significant predictor of QOLIE and a common co-morbidity among people with epilepsy [29, 31, 41]. In adults, depression and anxiety are the two most frequent mental health-related diagnoses in epilepsy [42, 43]. Depression in people with epilepsy though common sometimes escapes diagnosis even when necessary treatment is needed . In many cases, a combination of anti-epileptic use, psychotherapy and antidepressants are the most effective approach . The manifestation of depression in people with epilepsy has a significant negative toll on seizure control, sexual function, sleep, school or work performance, cognition and consequently on overall QOL. Our study is limited in that we restricted our cohort to females. We were able to identify determinants of QOL in WWE, but causality and relationship could not be ascertained because of the cross-sectional nature of the study especially with regard to medication effect. As such, we propose a prospective longitudinal study to further explore interplay among AEDs, hormones and QOL in WWE.
Overall, we demonstrated higher QOLIE-31 score in the LTM group across all domains except seizure worry. Furthermore, we identified predictors of poorer QOL in WWE from this study include medication effects, educational level, depression, background EEG frequency and duration of epilepsy. While we demonstrated association between progesterone, testosterone, prolactin and LH/FSH ratio with QOL, none of the hormones independently predicts the QOL on linear regression analysis.
Availability of data and materials
The data will be made available upon reasonable request, the principal investigator, will make the data available.
Quality of Life
Women with epilepsy
International League Against Epilepsy
Quality of Life Inventory Scale 31
Zung Self-Rating Depression Scale
Patients with epilepsy
Central nervous system
Follicle stimulating hormone
One-way analysis of variance
Arinzechi EO, Ogunrin OA, Nwosu CM, Nwani PO, Enwereji KO, Asomugha LA, et al. Seizure frequency and risk of cognitive impairment in people living with epilepsy in a sub-urban community in South Eastern Nigeria. J Clin Neurosci. 2019;59:98–105.
Ogunrin O, Adamolekun B, Ogunniyi AO, Aldenkamp AP. Cognitive function in Nigerians with newly diagnosed epilepsy. Can J Neurol Sci. 2000;27(2):148–51.
Saadi A, Patenaude B, Mateen FJ. Quality of life in epilepsy-31 inventory (QOLIE-31) scores: a global comparison. Epilepsy Behav. 2016;65:13–7.
Yue L, Yu PM, Zhao DH, Wu DY, Zhu GX, Wu XY, et al. Determinants of quality of life in people with epilepsy and their gender differences. Epilepsy Behav. 2011;22(4):692–6.
Harden CL, Pennell PB. Neuroendocrine considerations in the treatment of men and women with epilepsy. Lancet Neurol. 2013;12(1):72–83.
Amini L, Hematian M, Montazeri A, Gharegozli K. Comparing the frequency of polycystic ovary syndrome in women with and without epilepsy. J Fam Med Prim Care. 2018;7(1):16–20.
Harden CL, Meador KJ, Pennell PB, Hauser WA, Gronseth GS, French JA, et al. Practice parameter update: management issues for women with epilepsy–focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73(2):133–41.
George J, Kulkarni C, Sarma GRK. Antiepileptic drugs and quality of life in patients with epilepsy: a tertiary care hospital-based study. Value Health Reg Issues. 2015;6:1–6.
López-Góngora M, Martínez-Domeño A, García C, Escartín A. Effect of levetiracetam on cognitive functions and quality of life: a one-year follow-up study. Epileptic Disord. 2008;10(4):297–305.
Velíšková J, DeSantis KA. Sex and hormonal influences on seizures and epilepsy. Horm Behav. 2013;63(2):267–77.
Fadare JO, Sunmonu TA, Bankole IA, Adekeye KA, Abubakar SA. Medication adherence and adverse effect profile of antiepileptic drugs in Nigerian patients with epilepsy. Neurodegener Dis Manag. 2018;8(1):25–36.
Olusanya A, Ogunleye O, Godman B, Fadare J, Danesi M. Adverse effects of carbamazepine monotherapy among patients in Nigeria: a pilot study and implications. J Comp Eff Res. 2017;6(1):33–42.
Ogundare T, Adebowale TO, Okonkwo OA. Quality of life among patients with epilepsy in Nigeria: predictors and barriers to routine clinical use of QOLIE-31. Qual Life Res. 2020. https://doi.org/10.1007/s11136-020-02643-x.
Bermeo-Ovalle A, Bringing EEG. Back to the future: use of cEEG in neurocritical care. Epilepsy Curr. 2019;19(4):243–5.
Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, et al. American clinical neurophysiology society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30(1):1–27.
Maganti RK, Rutecki P. EEG and epilepsy monitoring. Continuum (Minneap Minn). 2013;19(3):598–622.
Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: position paper of the ILAE commission for classification and terminology. Epilepsia. 2017;58(4):512–21.
Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82.
Ogunjimi L, Yaria J, Makanjuola A, Ogunniyi A. Sexual dysfunction among Nigerian women with epilepsy. Epilepsy Behav. 2018;83:108–12.
Adebayo PB, Akinyemi RO, Ogun SA, Ogunniyi A. Seizure severity and health-related quality of life of adult Nigerian patients with epilepsy. Acta Neurol Scand. 2014;129(2):102–8.
Jokelainen J, Timonen M, Keinänen-Kiukaanniemi S, Härkönen P, Jurvelin H, Suija K. Validation of the Zung self-rating depression scale (SDS) in older adults. Scand J Prim Health Care. 2019;37(3):353–7.
Romera I, Delgado-Cohen H, Perez T, Caballero L, Gilaberte I. Factor analysis of the Zung self-rating depression scale in a large sample of patients with major depressive disorder in primary care. BMC Psychiatry. 2008;14(8):4.
Dunstan DA, Scott N, Todd AK. Screening for anxiety and depression: reassessing the utility of the Zung scales. BMC Psychiatry. 2017;17(1):329.
Ogunjimi L, Yaria J, Makanjuola A, Alabi A, Osalusi B, Oboh D, et al. Polycystic ovarian syndrome in Nigerian women with epilepsy on carbamazepine/levetiracetam monotherapy. Acta Neurol Scand. 2021;143(2):146–53.
Bauer J, Isojärvi JIT, Herzog AG, Reuber M, Polson D, Taubøll E, et al. Reproductive dysfunction in women with epilepsy: recommendations for evaluation and management. J Neurol Neurosurg Psychiatry. 2002;73(2):121–5.
Herzog AG, Coleman AE, Jacobs AR, Klein P, Friedman MN, Drislane FW, et al. Interictal EEG discharges, reproductive hormones, and menstrual disorders in epilepsy. Ann Neurol. 2003;54(5):625–37.
Reddy DS. Neuroendocrine aspects of catamenial epilepsy. Horm Behav. 2013;63(2):254–66.
Mwangala PN, Kariuki SM, Nyongesa MK, Mwangi P, Chongwo E, Newton CR, et al. Cognition, mood and quality-of-life outcomes among low literacy adults living with epilepsy in rural Kenya: a preliminary study. Epilepsy Behav. 2018;85:45–51.
Nabukenya AM, Matovu JK, Wabwire-Mangen F, Wanyenze RK, Makumbi F. Health-related quality of life in epilepsy patients receiving anti-epileptic drugs at National Referral Hospitals in Uganda: a cross-sectional study. Health Qual Life Outcomes. 2014;12(1):12–49.
Sunmonu TA, Afolabi OT, Komolafe MA, Ogunrin AO. Patients’ knowledge about their disorder: perspective of patients with epilepsy in a tertiary health facility in southwestern Nigeria. Epilepsy Behav. 2011;20(3):556–60.
Grant AC, Prus N, Nakhutina L. Factors affecting quality of life in epilepsy in a multi-ethnic urban population. Epilepsy Behav. 2013;27(2):283–5.
Rudakova IG, Morozova OS, Kotov AS. Impact of the current antiepileptic drugs on quality of life of epileptic patients. Zh Nevrol Psikhiatr Im S S Korsakova. 2008;1(3):36–40.
Guekht A, Mizinova M, Ershov A, Guz D, Kaimovsky I, Messina P, et al. In-hospital costs in patients with seizures and epilepsy after stroke. Epilepsia. 2015;56(8):1309–13.
Herodes M, Oun A, Haldre S, Kaasik AE. Epilepsy in estonia: a quality-of-life study. Epilepsia. 2001;42(8):1061–73.
Cho JR, Koo DL, Joo EY, Yoon SM, Ju E, Lee J, et al. Effect of levetiracetam monotherapy on background EEG activity and cognition in drug-naïve epilepsy patients. Clin Neurophysiol. 2012;123(5):883–91.
Pennell PB. Hormonal aspects of epilepsy. Neurol Clin. 2009;27(4):941–65.
Luef G. Hormonal alterations following seizures. Epilepsy Behav. 2010;19(2):131–3.
Reddy DS. Testosterone modulation of seizure susceptibility is mediated by neurosteroids 3alpha-androstanediol and 17beta-estradiol. Neuroscience. 2004;129(1):195–207.
Okubadejo NU, Danesi MA, Aina OF, Ojini FI, Adeyemi JD, Olorunshola DA. Prospective case-control study of interictal depression and suicidal ideation in Nigerians with epilepsy. Niger Postgrad Med J. 2007;14(3):204–8.
Coppola G, Operto FF, Matricardi S, Verrotti A. Monitoring and managing depression in adolescents with epilepsy: current perspectives. Neuropsychiatr Dis Treat. 2019;15:2773–80.
Gaus V, Kiep H, Holtkamp M, Burkert S, Kendel F. Gender differences in depression, but not in anxiety in people with epilepsy. Seizure. 2015;32:37–42.
Chen B, Choi H, Hirsch LJ, Katz A, Legge A, Buchsbaum R, et al. Psychiatric and behavioral side effects of antiepileptic drugs in adults with epilepsy. Epilepsy Behav. 2017;76:24–31.
Pan Z, Grovu RC, Cha DS, Carmona NE, Subramaniapillai M, Shekotikhina M, et al. Pharmacological treatment of cognitive symptoms in major depressive disorder. CNS Neurol Disord Drug Targets. 2017;16(8):891–9.
Chaytor N, Ciechanowski P, Miller JW, Fraser R, Russo J, Unutzer J, et al. Long-term outcomes from the PEARLS randomized trial for the treatment of depression in patients with epilepsy. Epilepsy Behav. 2011;20(3):545–9.
We acknowledge Mrs Tosin Elegbede, Miss Ibironke Oyenuga, Stella Adeyemo and Idume Omowunmi for their assistance in data collection.
Ethical approval and consent to participate
This was obtained from joint review board of University of Ibadan/University College Hospital with assigned number of UI/EC/15/077. Participants for this study were fully informed on the research protocol detailing the purpose, method, risks, and benefits of the research. Each of the participant then voluntarily gave a written and well understood informed consent. The consent was translated to the local language for those who did not understand English language and the services of interpreters were employed. Participants were free to decline participation or withdraw from the study at any time without reprisal or loss of benefit. There were sections for the person giving the consent, person obtaining the consent and witnesses in the informed consent.
Consent for publication
There are no competing interest or competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Luqman, O., Joseph, Y., Akintomiwa, M. et al. Determinants of quality of life in Nigerian female patients with epilepsy on carbamazepine and levetiracetam monotherapy. Egypt J Neurol Psychiatry Neurosurg 59, 32 (2023). https://doi.org/10.1186/s41983-023-00631-9
- Quality of life
- Anti-epileptic drug