Fatigue in epilepsy: A systematic review and meta-analysis

PURPOSE To estimate the frequency and strength of fatigue in epilepsy patients. METHODS The MEDLINE, EMBASE, COCHRANE, Web of Science, and SCOPUS databases were searched, and hand-searched data were added. For inclusion, the studies had to be original research articles that included fatigue data from adult epilepsy patients. The strength was estimated using studies reporting fatigue scores of standardized inventories for the patients and healthy controls. The fatigue frequency was estimated based on studies reporting the number of fatigue events in patients. We also investigated risk factors for fatigue and the correlation of depression with fatigue in epilepsy patients. RESULTS Of 25,613 abstracts screened, we included 12 articles or proceedings with distinctive data. The Fatigue Severity Scale (FSS) was the most commonly used inventory for fatigue in epilepsy patients. Four studies compared FSS scores between 499 epilepsy patients and 295 healthy controls. The overall mean difference in the FSS scores was significant. Seven of the 12 studies reported the frequency of fatigue determined by the FSS for 700 epilepsy patients. As stated by the studies, the overall frequency of fatigue was 47.1%. The risk factors for fatigue in epilepsy patients were depression, sleep-related impairment, and sleep quality. Of the 12 studies, 7 revealed a significant correlation between depression and fatigue. CONCLUSIONS Fatigue is common in epilepsy patients and is closely correlated with depression. The identification and management of fatigue and its risk factors, especially depression, is mandatory for the management of epilepsy.