We compared epileptic patients with and without active GTC seizures to identify differences in 1) baseline patient characteristics, 2) patient-reported health outcome measures and 3) healthcare utilization.

Seizure types of varying severity may differentially affect patient wellbeing.  High GTC burden correlates with higher risk of sudden death, but the association between active GTCs and patient quality of life and healthcare resource utilization has not been well studied.

We prospectively surveyed patients at outpatient visits at the Cleveland Clinic from 2012 to 2017.   We analyzed data from 504 confirmed drug-resistant epilepsy patients (active seizures despite ≥ 2 AEDs).  All patients had “active” seizures (at least one seizure in the last 6 months) and a subset had “active GTCs” (at least one GTC in the last 6 months.)

51.2% of patients (n=258) had active GTCs. Compared to non-GTC epileptics, GTC patients were younger (38.9 vs 43.4 years), more likely to be black, single, actively smoking, on antidepressants, and to be living in a lower income area (all p values ≤ 0.01). GTC patients reported fewer seizures in the last four weeks than non-GTC epileptics (median [IQR]: 1 [0,3] vs. 1 [0,8], p=0.044), but had higher seizure severity (LSSS median 32.5 vs. 16, p=0.011), poorer quality of life (QOLIE-10 28 vs 25, p=0.044), more depression (PHQ-9: 9 vs 7, p=0.036), and more anxiety (GAD-7: 9 vs 7, p=0.044). GTC patients were more likely to report any ED visits in the last 3 months (56.2% vs. 48.8%, p=0.049), but not more hospitalizations.

Important baseline differences exist amongst patients with convulsions versus those without GTCs.  A poorer quality of life in patients with convulsions, coupled with higher rates of mood disorders and healthcare utilization despite an overall lower seizure frequency highlight the need for palliative and curative interventions that specifically address this seizure type.