Patient-reported outcome measures in patients with post-brain injury seizures

To quantify the association of antiseizure medication (ASM) adverse effects and recent seizure activity with validated patient-reported outcome measures (PROMs) in a heterogeneous cohort of patients with acute and progressive acquired brain injuries (ABI).

We conducted a cross-sectional analysis of patients with seizures or epilepsy secondary to ABI and seen in the Epilepsy Clinic at Massachusetts General Hospital from 2022 to 2024. Our PROMs outcomes included depression (PHQ-9), anxiety (GAD-7), and global mental (PROMIS-10-M) and physical health (PROMIS-10-P). We performed multivariable linear regression analysis to examine the associations of 1) medication adverse effects with PROMs and 2) time since last seizure with PROMs. We adjusted for ABI type, chronicity (time since ABI), age, and sex.

A total of 145 patients were included in the analysis. On adjusted analysis, medication adverse effects were associated with higher PHQ-9 (ß = 2.46, p = 0.004) and GAD-7 scores (ß = 3.03, p = 0.001), and lower PROMIS-10-M (ß = -8.97, p < 0.001) and PROMIS-10-P scores (ß = -6.95, p < 0.001). Recent seizure activity was associated with higher GAD-7 (ß = 2.26, p = 0.021) and lower PROMIS-10-M scores (ß = -5.34, p = 0.010), and PROMIS-10-P scores (ß = -5.26, p = 0.004). Patients with recent seizures had a borderline association with higher PHQ-9 scores (ß = 1.59, p = 0.070).

ASM adverse effects and recent seizure activity may be associated with worse patient reported outcomes. Future prospective studies that examine the utility of PROMs to guide individualized, longitudinal follow-up of patients with ABI and seizures are indicated. Such studies can guide balancing disease management with iatrogenic side effects and psychosocial support to maximize overall quality of life.