Is preserved consciousness during seizures associated with quality of life among patients with drug-resistant epilepsy?

Drug-resistant epilepsy is associated with reduced quality of life (QoL) due to a myriad of disease-related and psychosocial factors. Although consciousness during seizures is a core feature of seizure classification, its impact on QoL in people with epilepsy (PWE) is not well understood. This study aimed to address this gap by comparing QoL between PWE with focal aware (FA) versus impaired awareness (FIA) seizures. Sixty-nine adults with epilepsy completed the Quality of Life in Epilepsy-31 (QoLIE-31) inventory as part of their pre-surgical neuropsychological evaluation (FA: n = 26, FIA: n = 43). There was no group difference in seizure burden as defined by the proportion of comorbid focal to bilateral tonic-clonic seizures (FA:65.4 %; FIA: 79.1 %). People with FA seizures reported lower overall QoL than people with FIA seizures; sub-scale analyses revealed that seizure worry drives this effect. There was no difference in QoL between people with motor and non-motor FA seizures. Results suggest that FA seizures are burdensome on the QoL of PWE. FA seizures may contribute to seizure worry due to preserved awareness of aversive peri-ictal phenomenon. Findings suggest that clinical efforts should continue to be made to optimize seizure control in people with breakthrough FA seizures. Prospective longitudinal monitoring of QoL in trials of consciousness-targeting neurostimulation therapy is needed to determine if QoL changes as a function of improved peri-ictal consciousness following treatment.