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Abstract
Background and Objective Frailty is an important aspect of biological aging, referring to the increased vulnerability of individuals with frailty to physical and psychological stressors. While older adults with epilepsy are an important and distinct clinical group, there are no data on frailty in this population. We hypothesize that frailty will correlate with the seizure frequency and especially the tolerability of antiseizure medications (ASMs) in older adults with epilepsy.
Methods We recruited individuals aged 60 years or older with active epilepsy from 4 Canadian hospital centers. We reported the seizure frequency in the 3 months preceding the interview, while ASM tolerability was quantified using the Liverpool Adverse Events Profile (LAEP). We applied 3 measures of frailty: grip strength as a measure of physical frailty, 1 self-reported score (Edmonton frail score [EFS]), and 1 scale completed by a healthcare professional (clinical frailty scale [CFS]). We also administered standardized questionnaires measuring levels of anxiety, depression, functional disability, and quality of life and obtained relevant clinical and demographic data.
Results Forty-three women and 43 men aged 60–93 years were recruited, 87% of whom had focal epilepsy, with an average frequency of 3.4 seizures per month. Multiple linear regression and zero-inflated negative binomial regression models showed that EFS and CFS scores were associated with decreased ASM tolerability, each point increase leading to 1.83 (95% CI: 0.67–4.30) and 2.49 (95% CI: 1.27–2.39) point increases on the LAEP scale, respectively. Neither the EFS and CFS scores nor grip strength were significantly associated with seizure frequency. The EFS was moderately correlated with depression, anxiety, quality of life, and functional disability, demonstrating the best construct validity among the 3 tested measures of frailty.
Discussion The EFS was significantly, both statistically and clinically, associated with ASM tolerability. It also showed multiple advantages in performance while assessing for frailty in older adults with epilepsy, when compared with the 2 other measures of frailty that we tested. Future studies must focus on what role the EFS during epilepsy diagnosis may play in ASM selection among older adults with epilepsy.
Glossary
- ASMs=
- antiseizure medications;
- ADL=
- activities of daily living;
- CFS=
- clinical frailty scale;
- EFS=
- Edmonton frail score;
- ESI=
- epilepsy-specific comorbidity index;
- GAD-7=
- generalized anxiety disorder 7-item scale;
- LAEP=
- Liverpool Adverse Events Profile;
- MD=
- mean difference;
- NDDI-E=
- neurologic disorders depression inventory for epilepsy;
- QOLIE-10=
- quality of life in epilepsy 10-item scale;
- ZINBR=
- zero-inflated negative binomial regression
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Associate Editor Barbara Jobst, MD, PhD, FAAN.
CME Course: NPub.org/cmelist
- Received March 13, 2022.
- Accepted in final form November 1, 2022.
- © 2022 American Academy of Neurology
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