Positive illusions determine quality of life in drug-resistant epilepsy

Objective Humans use a complex system of protective cognitive biases or "positive illusions" that foster emotional well-being and subjective quality of life. This study examined the role of positive illusions in patient adjustment to drug-resistant epilepsy and its surgical treatment. Methods One hundred fifty people participated, including 93 focal epilepsy patients being evaluated for surgery and 57 sociodemographically matched healthy controls. We purpose-built computer software, "Living With Epilepsy," to assess the impact of positive illusions on patient perceptions of their current life, and administered well-validated questionnaires of depression (Neurological Disorders Depression Inventory for Epilepsy), anxiety (Patient Health Questionnaire for Generalized Anxiety Disorder-7 items), and health-related quality of life (HRQOL; Epilepsy Surgery Inventory-55) before and at 3 and 12 months after surgery. Results We identified two patient groups: those with "high positive illusions" (53%) about their epilepsy and those with "low positive illusions" (47%), with no differences between sociodemographic or epilepsy variables (all P > .05). Before epilepsy surgery, patients with high positive illusions exhibited fewer symptoms of depression (P < .001) and anxiety (P = .002) and higher HRQOL (P >= .002 <= 0.046) than those with low positive illusions. A subset of patients proceeded with surgery (n = 34 at 3 months; n = 26 at 12 months). They showed that the beneficial impact of having high positive illusions re-emerged 12 months postsurgery, with patients reporting lower depression and anxiety (P = .006) and elevated HRQOL (P = .036) compared to low positive illusions patients, independent of seizure outcome (P > .05). Significance These findings point to an active psychological process in drug-resistant patients, where approximately half generate strong positive illusions about their life with epilepsy, maintaining their mood and subjective well-being. Those who use this psychological mechanism show better adjustment 12 months postsurgery independent of seizure outcome, providing a potential new target for psychological treatment in patients with epilepsy.