Abstract

Quality of life (QoL) is a fundamental, yet frequently neglected, outcome measure in the treatment of persons with epilepsy, as the primary clinical goal is often focused on achieving a seizure-free state. While antiepileptic drugs (AEDs) are the mainstay of epilepsy management, a debate persists regarding whether newer-generation AEDs confer greater improvements in health-related QoL (HRQoL) compared to older agents. A systematic review was conducted to compare HRQoL scores between new and old AEDs in persons with epilepsy. A systematic search was conducted across six databases for studies that compared HRQoL, primarily measured using the QOLIE-31 or QOLIE-89 instruments, in epilepsy patients treated with a new AED versus an old AED. Twenty-one studies, encompassing a total of 4,700 participants, indicated that newer AEDs were associated with significantly better outcomes in overall HRQoL [standardized mean difference (SMD) = 0.32; 95% confidence interval (CI): 0.18-0.46; p < 0.001]. Significant benefits were also observed in specific domains, most notably in cognitive functioning (SMD = 0.45) and emotional well-being (SMD = 0.38). Specific agents, such as lamotrigine (mean HRQoL score 72.1) and levetiracetam (mean 69.8), demonstrated superior performance compared to older agents like phenytoin (mean 59.8). Furthermore, monotherapy was associated with improved HRQoL outcomes over polytherapy (SMD = 0.41; p < 0.001), while adverse events had a more pronounced negative impact on scores with older AEDs (β = −0.52; p < 0.001). It was concluded that newer AEDs achieved better improvements in HRQoL, particularly in the cognitive and emotional domains.

Key words: health-related quality of life, HRQoL scores, antiepileptic drugs, epilepsy, systematic review