Comprehensive Epilepsy Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
More than 50 years ago, Lennox and Markham urged physicians who treated patients with epilepsy to “match modern drug and surgical therapy with practical sociopsychological therapy” and to be “concerned not only with turbulent brain waves but with disturbed emotions”. Indeed, while seizure frequency and severity correlate with quality of life and psychosocial outcomes for patients with drug-resistant epilepsy, numerous other epilepsy-related factors may also be significant determinants. These factors include medical and psychiatric co-morbidities, side effects of therapy, stigma, parental anxiety, employment status, seizure worry, self-esteem and self-mastery. Importantly, these epilepsy-related factors may be amenable to educational or therapeutic interventions, which if successful may benefit patients even without a concomitant reduction in seizure frequency or severity. Therefore, while further research is needed, physicians and other health care providers should comprehensively attend to these factors and refer patients with treatment-resistant seizures, when appropriate, for further evaluation and treatment to improve their quality of life beyond seizure control.