The number of anti-seizure medications mediates the relationship between cognitive performance and quality of life in temporal lobe epilepsy.

• Epitrack total score significantly contributes to better QOL composite score. • Epitrack total score contributes to perceived energy and cognitive self-rating. • The number of ASMs mediates the relationship between cognitive deficits and QOL. • The DDD of ASMs does not mediate the association between cognition and QOL. To assess whether cognitive performance predicts quality of life (QOL) in patients with drug-resistant temporal lobe epilepsy (TLE), using the Epitrack cognitive screening tool, while considering the mediating role of the number of anti-seizure medications (ASMs) and controlling for seizure-related, social, and emotional factors. Seventy-five adult patients with drug-resistant TLE (mean age = 39.76 years, SD = 11.66) underwent a presurgical neuropsychological assessment. Main Outcome Measures: Cognitive performance (Epitrack), depression (BDI-II), trait anxiety (STAI); and QOL (QOLIE-31) were assessed. Adjusting for seizure-related, social, and emotional factors, the Epitrack total score significantly contributed to QOL composite score, and energy and cognitive self-rating subscales. We found a significant indirect effect of the Epitrack total score on QOL composite score and seizure worry and social functioning subscales via the number of ASMs. Our findings underline the relevance of cognitive functioning on QOL and the clinical utility of Epitrack to track cognitive side effects of ASMs and, consequently, to predict and manage QOL in this population. [ABSTRACT FROM AUTHOR]