Impact of interaction among antiseizure medication polytherapy, clinical, sociodemographic and psychological factors on quality of life in patients with epilepsy: A systematic review

Abstract

Drug-resistant epilepsy usually requires polytherapy with antiseizure medications (ASMs), potentially impacting quality of life (QOL) through side effects. This systematic review evaluates evidence linking ASM polytherapy to QOL, considering clinical, sociodemographic, and psychological variables. Following PRISMA guidelines, 34 studies were analyzed. Thirty studies addressed the association between the number of ASMs and QOL, with 93.3% reporting poorer QOL with increased medications. Fifteen studies comparing polytherapy and monotherapy consistently found lower QOL in polytherapy patients. Furthermore, 32 studies highlighted additional influential factors, identifying seizure frequency and mood disorders (depression, anxiety) as significant predictors of reduced QOL. Despite its necessity, polytherapy substantially impairs QOL. Effective seizure management is crucial, but enhancing QOL requires a comprehensive approach targeting mental health and social determinants. Future research should aim to optimize therapeutic strategies to balance seizure control with minimal QOL impact.