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Improving Outcomes in Epilepsy
Frank Gilliam, MD, MPH Professor of Neurology University of
Kentucky
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Disclosure
• No relevant financial relationships with commercial
supporters
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Learning Objectives
Upon completion of this education activity, participants will be
able to: • Identify patient-oriented preferences for
outcomes in epilepsy • Implement valid instruments to assess
outcomes in epilepsy • Utilize results of systematic screening
to guide
clinical care
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Application of Patient Reported Outcomes in Clinical Care
• Historical Review • Clinical PROs associated with HQOL •
Example of a RCT of Clinical Utility of a PRO
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Depression and Health Status in Epilepsy
Boylan et al, 2004
Gilliam et al, 2002
Jones et al, 2002
Gilliam et al, 2002
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Depression and AED side effects predict health status in
epilepsy
3
R2 = 0.72
AEP and NDDI-E summary scores
100
80
60
40
20
0 0 0 10 20 30 40 50 60 70
QO
LIE-
89 su
mm
ary
scor
es
Correlation of QOLIE-89 summary scores with NDDI-E and AEP
Gilliam et al. Lancet Neurol 2006;5:399-405.
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Determinants of Subjective Health in Pharmacoresistant
Epilepsy
Adverse AED effects
36%
Depression 25%
Seizure rate 2%
Other 29%
Memory 8%
Perrine et al. Arch of Neuro, 1996. Johnson et al. Epilepsia
45:5 544, 2004 Gilliam Neurology 58:9-19, 2002 Gilliam et al.
Lancet Neurology, 2006
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Baker et al Epilepsia 39:213-231, 1998
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RCT of the Clinical Utility of the Adverse Events Profile
AEP > 45 RA
AEP-Provided
AEP-Inaccessible
--16 Weeks--
Outcomes AEP QOLIE-89 Seizure Rate AED changes Visits
n = 62
n=200 screened
Gilliam et al. Neurology 2004;62:23-27 Supported by NINDS grants
NS01794, NS40808, and NS047551
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Adverse Event Profile Score
7560453015
QO
LIE-
89 T
otal
Sco
re
100
80
60
40
20
0
AED Toxicity and Subjective Health
(n=200, r = -0.78, p< 0.0001) Gilliam et al. Neurology
2004;62:23-27
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Yes No Physician Received AEP
5
10
15
20
25
30 %
Impr
ovem
ent i
n AE
P Sc
ore
t test p value = 0.01
Gilliam et al. Neurology 2004;62:23-27
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AEP Study Results
0.71 5% -17% Seizure Rate
15
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1H-MR Spectroscopy and Depression in TLE
Spearman rho = 0.65, p
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1H-MR Spectroscopy and Depression TLE
Gilliam et al. Neurology 68:364-368, 2007
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Neurological Disorders Depression Inventory in Epilepsy (NDDI-E)
For the statements below, please circle the number that best
describes you over the last two weeks including today.
1 2 3 4 Difficulty finding pleasure
1 2 3 4 I’d be better off dead
1 2 3 4 Feel guilty
1 2 3 4 Nothing I do is right
1 2 3 4 Frustrated
1 2 3 4 Everything is a struggle
Never Rarely Sometimes Always or Often
Gilliam et al. Lancet Neurology. 5:399-405, 2006
Slide Number 1DisclosureLearning ObjectivesSlide Number
4Application of Patient Reported Outcomes in Clinical CareSlide
Number 6Slide Number 7Depression and Health Status in
EpilepsyDepression and AED side effects predict health status in
epilepsySlide Number 10Slide Number 11RCT of the Clinical Utility
of the Adverse Events ProfileSlide Number 13Slide Number 14AEP
Study Results1H-MR Spectroscopy and Depression in TLESlide Number
171H-MR Spectroscopy and Depression TLENeurological Disorders
Depression Inventory in Epilepsy (NDDI-E)�For the statements below,
please circle the number that best describes you over the last two
weeks including today.
