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Phimha S, Sirikarn P, Tiamkao S. Economic burden and determinants among hospitalized patients with epilepsy in Thailand. BMC Health Serv Res 2025; 25:413. [PMID: 40114158 PMCID: PMC11927340 DOI: 10.1186/s12913-025-12504-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 02/28/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Epilepsy has a significant impact on individuals' lives, as well as on society and the economy, due to its unpredictable nature and the financial burden it places on those affected. Even though Thai citizens hold health benefits or health insurance, excess costs can occur; thus, this study aimed to describe the direct medical costs among hospitalized patients with epilepsy from both social and patient perspectives. Moreover, the factors associated with costs were investigated. METHODS This was a prevalence-based cost-of-illness study using data from the Thailand National Health Security Office database. Patients who were diagnosed with epilepsy (ICD-10 code G40) and admitted to the hospital in the fiscal year 2022 were included. Direct medical costs were reported from societal and patient perspectives. A generalized linear model with gamma distribution and log-link function was employed to investigate the factors influencing these costs. RESULTS Among 31,635 epilepsy visits, the mean direct medical costs from a societal and patient perspective were 1,043.45 PPP-USD and 14.02 PPP-USD per visit, respectively. From a societal perspective, patients who underwent procedures experienced a substantial increase of 120.9% in costs compared to those without procedures, while hospital stays exceeding one week showed a significant 750.1% increase in costs compared to shorter stays. Furthermore, female sex, older age, and the presence of comorbidities or complications significantly increase costs. From the patient's perspective, those with comorbidities or complications during admission had a 56.0% increase compared to those without such conditions. Moreover, elderly patients, those who underwent procedures, and individuals with extended hospital stays were associated with increased costs. CONCLUSIONS Factors influencing costs were hospital stay duration, comorbidities or complications, and types of procedures.
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Affiliation(s)
- Surachai Phimha
- Department of Public Health Administration, Health Promotion, and Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
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Rauh R, Auvin S, Schulze-Bonhage A. Between fear of death and just a warning sign: Seizure severity scales neglect the subjective quality of periictal perceptions. Epilepsy Behav 2024; 159:110020. [PMID: 39216465 DOI: 10.1016/j.yebeh.2024.110020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/19/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
The burden of epilepsy is not only related to seizure frequency; the severity of epileptic seizures considerably affects patient's lives. A number of seizure severity scales have thus been developed for a systematic assessment. Items considered relevant in these scales mainly pertain to objective features, such as seizure duration, loss of consciousness, and seizure-related injuries. In contrast, subjective experiences of seizures are considered only in their functionality as "warnings", whereas the quality of subjective perceptions and feelings are disregarded phenomena. This leads to a gap between the often-distressing subjective experiences which people with epilepsy remember from their seizures and the perception of physicians which may negatively impact physician-patient communication and interaction and question their valid use as treatment outcomes. We advocate here to develop new seizure severity assessments in collaboration with patient organizations which integrate also the subjective quality of seizures.
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Affiliation(s)
- Raphael Rauh
- Epilepsy Center, University Medical Center, University of Freiburg, Germany
| | - Stephane Auvin
- Paris-Cité University & Robert-Debré University Hospital Paris, France; APHP, Robert Debré University Hospital, Pediatric Neurology Department, CRMR Epilepsies Rares, Member of ERN EpiCARE, Paris, France; Université Paris Cité, INSERM NeuroDiderot, Paris, France; Institut Universitaire de France (IUF), Paris, France; EpiCare, European Reference Network Epilepsy
| | - Andreas Schulze-Bonhage
- Epilepsy Center, University Medical Center, University of Freiburg, Germany; EpiCare, European Reference Network Epilepsy.
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Mitchell JW, Sossi F, Miller I, Jaber PB, Das-Gupta Z, Fialho LS, Amos A, Austin JK, Badzik S, Baker G, Zeev BB, Bolton J, Chaplin JE, Cross JH, Chan D, Gericke CA, Husain AM, Lally L, Mbugua S, Megan C, Mesa T, Nuñez L, von Oertzen TJ, Perucca E, Pullen A, Ronen GM, Sajatovic M, Singh MB, Wilmshurst JM, Wollscheid L, Berg AT. Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Adults with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations. Epilepsia 2024; 65:1916-1937. [PMID: 38738754 DOI: 10.1111/epi.17971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 05/14/2024]
Abstract
At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. Therefore, the International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy and their representatives to develop minimum sets of standardized outcomes and outcomes measurement methods for clinical practice that support patient-clinician decision-making and quality improvement. Consensus methods identified 20 core outcomes. Measurement tools were recommended based on their evidence of strong clinical measurement properties, feasibility, and cross-cultural applicability. The essential outcomes included many non-seizure outcomes: anxiety, depression, suicidality, memory and attention, sleep quality, functional status, and the social impact of epilepsy. The proposed set will facilitate the implementation of the use of patient-centered outcomes in daily practice, ensuring holistic care. They also encourage harmonization of outcome measurement, and if widely implemented should reduce the heterogeneity of outcome measurement, accelerate comparative research, and facilitate quality improvement efforts.
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Affiliation(s)
- James W Mitchell
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK
| | - Frieda Sossi
- International Consortium for Health Outcomes Measurement, London, UK
| | - Isabel Miller
- International Consortium for Health Outcomes Measurement, London, UK
| | | | - Zofia Das-Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | - Luz Sousa Fialho
- International Consortium for Health Outcomes Measurement, London, UK
| | - Action Amos
- International Bureau for Epilepsy, Africa Region, University of Edinburgh, Edinburgh, UK
| | - Joan K Austin
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Scott Badzik
- Lived Experience Representative, Cincinnati, Ohio, USA
| | - Gus Baker
- University of Liverpool, Liverpool, UK
| | - Bruria Ben Zeev
- The Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - J Helen Cross
- Developmental Neurosciences Dept, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Derrick Chan
- KK Women's and Children's Hospital, Duke-NUS, Singapore
| | - Christian A Gericke
- The University of Queensland Medical School, Brisbane, Queensland, Australia
| | - Aatif M Husain
- Duke University Medical Center and Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Lorraine Lally
- LLM (International Human Rights Law), LLM (Financial Services Law), Galway, Ireland
| | | | | | - Tomás Mesa
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lilia Nuñez
- Centro Medico Nacional 20 de Noviembre, Médica Sur, Mexico City, Mexico
| | - Tim J von Oertzen
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Emilio Perucca
- Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Gabriel M Ronen
- Department of Pediatrics, CanChild Centre for Childhood Disability Research, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Martha Sajatovic
- Departments of Psychiatry and of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mamta B Singh
- All Indian Institute of Medicine Sciences, New Delhi, India
| | - Jo M Wilmshurst
- Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Anne T Berg
- Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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Cho S, Lee HJ, Lee SH, Kim KM, Chu MK, Kim J, Heo K. Long-term outcome of treatment-naïve patients with mesial temporal lobe epilepsy with hippocampal sclerosis: A retrospective study in a single center. Seizure 2024; 117:36-43. [PMID: 38308907 DOI: 10.1016/j.seizure.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024] Open
Abstract
PURPOSE This study aimed to describe long-term treatment outcomes of treatment-naïve patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). METHODS A retrospective review was conducted of treatment-naïve patients with MTLE-HS who visited the Yonsei Epilepsy Clinic from April 2000 to April 2022 and were followed up for at least 2 years. Seizure freedom (SF) was defined as no seizures or auras only for >1 year, and complete SF was defined as no seizures including auras for >1 year. RESULTS Eighty-four treatment-naïve patients with MTLE-HS with a median follow-up of 122 months were included. Except for one patient who underwent early surgical treatment, of the remaining 83 patients, 31 (37.3 %) achieved SF and remained in remission, 38 (45.8 %) had fluctuations in seizure control, and 14 (16.9 %) never achieved SF. Additionally, 18 (21.7 %) patients achieved complete SF and remained in remission, 42 (50.6 %) showed fluctuations, and 23 (27.7 %) never achieved complete SF. Fifty-three (63.9 %) patients achieved SF and 34 (41.0 %) achieved complete SF at their last visit. Older age at epilepsy onset, male sex, low pretreatment seizure density, history of central nervous system infection before age 5, absence of aura, and fewer antiseizure medications in the final regimen were associated with favorable outcome. Of the 84 patients, 11 (13.1 %) underwent temporal lobectomy. CONCLUSIONS Medical treatment outcomes in treatment-naïve MTLE-HS were relatively better than previously reported outcomes in MTLE-HS, although frequent fluctuations in seizure control were observed.
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Affiliation(s)
- Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Jeong Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Sue Hyun Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Peek SI, Meller S, Twele F, Packer RMA, Volk HA. Epilepsy is more than a simple seizure disorder: Parallels between human and canine cognitive and behavioural comorbidities. Vet J 2024; 303:106060. [PMID: 38123061 DOI: 10.1016/j.tvjl.2023.106060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
Psychiatric and cognitive comorbidities have been known to play a major role in human epilepsy for a long time. People with epilepsy (PWE) frequently express signs of varying psychiatric and cognitive disorders affecting their quality and quantity of life (QoL/QaoL). Over the last few years, research on behavioural comorbidities and their effect on the underlying disease have been performed in canine epilepsy. The following article reviews manifestations of comorbidities in canine epilepsy with an emphasis on patterns of clinical signs and their effects on QoL and QaoL. Cognitive and behavioural alterations in epileptic dogs are mainly represented by fear-/anxiety related behaviour and cognitive impairment (CI). Reduced trainability and altered reactions to daily situations are common results of comorbid changes posing obstacles in everyday life of owners and their dog. In addition, clinical signs similar to attention deficit hyperactivity disorder (ADHD) in humans have been reported. Canine attention-deficit-hyperactivity-disorder-like (c-ADHD-like) behaviour should, however, be evaluated critically, as there are no official criteria for diagnosis of ADHD or ADHD-like behaviour in dogs, and some of the reported signs of c-ADHD-like behaviour could be confused with anxiety-associated behaviour. Many intrinsic and extrinsic factors could potentially influence the development of behavioural and cognitive comorbidities in canine epilepsy. In particular, seizure frequency/severity, signalment and factors concerning disease management, such as pharmacotherapy and nutrition, are closely linked with the presence of the aforementioned comorbid disorders. Further studies of behavioural alterations in epileptic dogs are needed to comprehend the complexity of clinical signs and their multifactorial origin.
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Affiliation(s)
- Saskia I Peek
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Sebastian Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Friederike Twele
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | | | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany.
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Toluwalashe S, Aremu O, Ekerin O, Lawal A, Oluwatobi F, Adebayo V, Akingbola A, Olaniyan S, Progress A, Aborode AT. Seizure Susceptibility in E-cigarette Users: Navigating the Clinical Management and Public Health Considerations. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:29768357241304298. [PMID: 39618920 PMCID: PMC11607758 DOI: 10.1177/29768357241304298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 11/13/2024] [Indexed: 03/17/2025]
Abstract
E-cigarettes gained popularity globally through the promotion of e-cigarettes as a risk-free way to stop traditional smoking. However, new evidence suggests that they may have a detrimental effect on the nervous system and ultimately adverse neurological manifestations. Seizures have been reported among both new and experienced e-cigarette users. In several cases, the seizure presented immediately after its use, while others reported continuous use for weeks before seizures occurred. This review presents a deeper insight into the clinical management, implications, and public health considerations of seizure susceptibility in e-cigarette users. Using recent case reports, epidemiological studies, and experimental research, we highlight the role of likely etiological mechanisms such as how nicotine's convulsive effects are linked to α7- nicotinic acetylcholine receptors (nAChRs), the varied clinical presentations, and the potential nicotine toxicity linked to seizures. Furthermore, we discuss the existing debates and controversies, diagnostic directions, and potential role in individual susceptibility to e-cigarette-associated seizures. Importantly, we address how seizures may be accompanied by both physical and psychological sequelae, which may impair the quality of life for individuals presenting for emergency care. We also address the limitations and challenges in the etiology of e-cigarette-associated seizures and the non-criteria for defining seizures caused by e-cigarettes. The review concludes with an insight into public health considerations and policy recommendations by highlighting the importance of mass awareness and clinical considerations that could guide patient management.
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Affiliation(s)
- Soyemi Toluwalashe
- Faculty of Clinical Sciences, Lagos State University College of Medicine, Lagos, Nigeria
| | - Olusola Aremu
- Faculty of Clinical Sciences, Lagos State University College of Medicine, Lagos, Nigeria
| | - Olabode Ekerin
- School of Public Health, University of Port Harcourt, Port-Harcourt, Rivers, Nigeria
| | - Abdulqudus Lawal
- Faculty of Clinical Sciences, Lagos State University College of Medicine, Lagos, Nigeria
| | - Faniyi Oluwatobi
- Faculty of Clinical Sciences, Lagos State University College of Medicine, Lagos, Nigeria
| | - Victor Adebayo
- Faculty of Clinical Sciences, Lagos State University College of Medicine, Lagos, Nigeria
| | - Adewunmi Akingbola
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon Olaniyan
- Faculty of Clinical Sciences, Lagos State University College of Medicine, Lagos, Nigeria
| | - Agboola Progress
- Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
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Ben-Menachem E, Schmitz B, Kälviäinen R, Thomas RH, Klein P. The burden of chronic drug-refractory focal onset epilepsy: Can it be prevented? Epilepsy Behav 2023; 148:109435. [PMID: 37748414 DOI: 10.1016/j.yebeh.2023.109435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
Despite the many therapeutic options for epilepsy available today, a third of patients still have poorly controlled epilepsy. Over the years, their transition through lines of treatment exposes them to increased risk of disease progression, mortality, morbidity, mental distress, and not least significantly impaired quality of life (QoL). The present review explores the multiple factors contributing to the impairment of health-related QoL in PWE-including both seizure-related and non seizure-related. The analysis aims to identify potential areas of intervention and strategies for a more holistic approach to epilepsy care and inform policy-makers and healthcare providers in their approach to this condition.
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Affiliation(s)
| | - Bettina Schmitz
- Neurology/Center for Epilepsy, Stroke Unit and Neurological Rehabilitation, Vivantes Humboldt Hospital, Berlin, Germany.
| | | | - Rhys H Thomas
- Department of Neurology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle-Upon-Tyne NE1 4LP, United Kingdom; Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, United Kingdom.
| | - Pavel Klein
- Department of Neurology, George Washington University, Boston, United States.
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Biresaw MS, Irawan A, Halász P, Szucs A. Unfavorable public attitude toward people with epilepsy in Ethiopia: A systematic review and meta-analysis study. Epilepsia Open 2023; 8:1054-1063. [PMID: 37394990 PMCID: PMC10472419 DOI: 10.1002/epi4.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis aims to show the pooled prevalence of unfavorable public attitude toward people with epilepsy (UPATPWE) as well as the effect estimates of associated factors in Ethiopia. METHODS Between December 1 and 31, 2022, we searched for the English version of published research reports on public attitude toward epilepsy in Ethiopia in PubMed/Medline, Science Direct, Cochrane Library, Google Scholar, and PsycINFO. The research reports' quality was assessed using the Newcastle-Ottawa Scale. We extracted the relevant information from the searched papers in a Microsoft Excel format and imported it to STATA version 15.0, for analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reports guideline was used. A random-effects meta-analysis model was used to estimate the Der Simonian and Laird's pooled prevalence of unfavorable public attitude and its associated factors. RESULTS Nine out of the accessed 104 research papers meeting the pre-specified criteria were included in this study. The overall pooled prevalence of UPATPWE in Ethiopia is 52.06 (95% CI: 37.54, 66.59), resulting in excommunication, physical punishments, and assaults against people with epilepsy as well as frequent lack of diagnosis and proper treatment. The pooled effect estimates for witnessing a seizure episode were done and it was (AOR = 2.70 [95% CI: 1.13, 6.46]). SIGNIFICANCE As interventions and new strategies to change attitudes and facilitate a supportive, positive, and socially inclusive environment for PWE may root in education and scientific research outputs, our result hopefully evokes the policy makers' attention for building a well-designed and comprehensive health education and campaign strategy.
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Affiliation(s)
| | - Anggi Irawan
- Doctoral School of Mental Health SciencesSemmelweis UniversityBudapestHungary
| | - Peter Halász
- Department of NeurologyUniversity of Pécs Medical SchoolPécsHungary
- Epilepsy CenterNational Institute of NeurosurgeryBudapestHungary
| | - Anna Szucs
- Department of Behavioral SciencesSemmelweis UniversityBudapestHungary
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Pattnaik AR, Ghosn NJ, Ong IZ, Revell AY, Ojemann WKS, Scheid BH, Georgostathi G, Bernabei JM, Conrad EC, Sinha SR, Davis KA, Sinha N, Litt B. The seizure severity score: a quantitative tool for comparing seizures and their response to therapy. J Neural Eng 2023; 20:10.1088/1741-2552/aceca1. [PMID: 37531949 PMCID: PMC11250994 DOI: 10.1088/1741-2552/aceca1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/01/2023] [Indexed: 08/04/2023]
Abstract
Objective.Epilepsy is a neurological disorder characterized by recurrent seizures which vary widely in severity, from clinically silent to prolonged convulsions. Measuring severity is crucial for guiding therapy, particularly when complete control is not possible. Seizure diaries, the current standard for guiding therapy, are insensitive to the duration of events or the propagation of seizure activity across the brain. We present a quantitative seizure severity score that incorporates electroencephalography (EEG) and clinical data and demonstrate how it can guide epilepsy therapies.Approach.We collected intracranial EEG and clinical semiology data from 54 epilepsy patients who had 256 seizures during invasive, in-hospital presurgical evaluation. We applied an absolute slope algorithm to EEG recordings to identify seizing channels. From this data, we developed a seizure severity score that combines seizure duration, spread, and semiology using non-negative matrix factorization. For validation, we assessed its correlation with independent measures of epilepsy burden: seizure types, epilepsy duration, a pharmacokinetic model of medication load, and response to epilepsy surgery. We investigated the association between the seizure severity score and preictal network features.Main results.The seizure severity score augmented clinical classification by objectively delineating seizure duration and spread from recordings in available electrodes. Lower preictal medication loads were associated with higher seizure severity scores (p= 0.018, 97.5% confidence interval = [-1.242, -0.116]) and lower pre-surgical severity was associated with better surgical outcome (p= 0.042). In 85% of patients with multiple seizure types, greater preictal change from baseline was associated with higher severity.Significance.We present a quantitative measure of seizure severity that includes EEG and clinical features, validated on gold standard in-patient recordings. We provide a framework for extending our tool's utility to ambulatory EEG devices, for linking it to seizure semiology measured by wearable sensors, and as a tool to advance data-driven epilepsy care.
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Affiliation(s)
- Akash R Pattnaik
- Department of Bioengineering, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Nina J Ghosn
- Department of Bioengineering, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Ian Z Ong
- Department of Bioengineering, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Andrew Y Revell
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - William K S Ojemann
- Department of Bioengineering, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Brittany H Scheid
- Department of Bioengineering, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Georgia Georgostathi
- Department of Bioengineering, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - John M Bernabei
- Department of Bioengineering, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Erin C Conrad
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Saurabh R Sinha
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Kathryn A Davis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Nishant Sinha
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- These authors contributed equally to this work
| | - Brian Litt
- Department of Bioengineering, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America
- These authors contributed equally to this work
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10
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Ebadi SR, Saleki K, Adl Parvar T, Rahimi N, Aghamollaii V, Ranji S, Tafakhori A. The effect of cannabidiol on seizure features and quality of life in drug-resistant frontal lobe epilepsy patients: a triple-blind controlled trial. Front Neurol 2023; 14:1143783. [PMID: 37470002 PMCID: PMC10352113 DOI: 10.3389/fneur.2023.1143783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/09/2023] [Indexed: 07/21/2023] Open
Abstract
Background Treatment-resistant epileptic seizures are associated with reduced quality of life (QoL). As polypharmacy with routine antiseizure medications has many side effects, novel add-on treatments are necessary. Recent research showed the efficacy of add-on therapy by cannabidiol (CBD) on refractory epilepsy. We attempted to extend data on the efficacy and safety profile of CBD in patients with frontal lobe treatment-resistant epilepsy. Methods A total of 27 patients were recruited into two CBD (n = 12) and placebo (n = 15) groups. The CBD group received a highly purified liposomal preparation of the drug in addition to routine antiseizure medications. The placebo group only received antiseizure medications. This experiment followed a triple-blinding protocol. Outcome measures were seizure frequency, the Chalfont seizure severity scale (CSSS), and the quality of life questionnaire score (QOLIE-31) assessed at baseline, 4 weeks, and 8 weeks. Results At 4 weeks, results indicated that a higher fraction of patients in the CBD group (66.67%) showed improvement in seizure, compared to the placebo group (20.00%). Before-after comparison revealed that CBD, unlike routine ADEs, was effective in reducing the occurrence of seizures at the study's final timepoint [mean difference 45.58, 95% CI (8.987 to 82.18), p = 0.009]. Seizure severity was not affected by study groups or time intervals (repeated-measures ANOVA p > 0.05). Post-hoc tests found that the QoLI-31 score was improved at 8 weeks compared to baseline [mean diff. -5.031, 95% CI (-9.729 to -0.3328), p = 0.032]. The difference in cases who experienced enhanced QoL was meaningful between the CBD and placebo groups at 8 weeks [RR: 2.160, 95% CI (1.148 to 4.741), p = 0.018] but not at 4 weeks (p = 0.653). A positive finding for QoL improvement was associated with a positive finding for seizure frequency reduction [r = 0.638, 95% CI (0.296 to 0.835), p = 0.001]. Interestingly, limiting the correlation analysis to cases receiving CBD indicated that QoL improvement was not linked with seizure parameters such as severity and frequency (p > 0.05). Conclusion The present study suggests the benefit of a purified and highly efficient preparation of CBD for seizure frequency reduction and improvement of QoL in refractory frontal lobe epilepsy. Further study with longer follow-ups and larger sample size is advised. Clinical trial registration https://www.irct.ir/trial/56790, identifier: IRCT20210608051515N1.
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Affiliation(s)
- Seyyed Reza Ebadi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiarash Saleki
- School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | - Tanin Adl Parvar
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Rahimi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vajiheh Aghamollaii
- Cognitive Neurology and Neuropsychiatry Division, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Roozbeh Psychiatric Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Ranji
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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11
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Ots HD, Anderson T, Sherrerd-Smith W, DelBianco J, Rasic G, Chuprin A, Toor Z, Fitch E, Ahuja K, Reid F, Musto AE. Scoping review of disease-modifying effect of drugs in experimental epilepsy. Front Neurol 2023; 14:1097473. [PMID: 36908628 PMCID: PMC9997527 DOI: 10.3389/fneur.2023.1097473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Epilepsy affects ~50 million people worldwide causing significant medical, financial, and sociologic concerns for affected patients and their families. To date, treatment of epilepsy is primarily symptomatic management because few effective preventative or disease-modifying interventions exist. However, recent research has identified neurobiological mechanisms of epileptogenesis, providing new pharmacologic targets to investigate. The current scientific evidence remains scattered across multiple studies using different model and experimental designs. The review compiles different models of anti-epileptogenic investigation and highlights specific compounds with potential epileptogenesis-modifying experimental drugs. It provides a platform for standardization of future epilepsy research to allow a more robust compound analysis of compounds with potential for epilepsy prevention. Methods PubMed, Ovid MEDLINE, and Web of Science were searched from 2007 to 2021. Studies with murine models of epileptogenesis and explicitly detailed experimental procedures were included in the scoping review. In total, 51 articles were selected from 14,983 and then grouped by five core variables: (1) seizure frequency, (2) seizure severity, (3) spontaneous recurrent seizures (SRS), (4) seizure duration, and (5) mossy fiber sprouting (MFS). The variables were differentiated based on experimental models including methods of seizure induction, treatment schedule and timeline of data collection. Data was categorized by the five core variables and analyzed by converting original treatment values to units of percent of its respective control. Results Discrepancies in current epileptogenesis models significantly complicate inter-study comparison of potential anti-epileptogenic interventions. With our analysis, many compounds showed a potential to reduce epileptogenic characteristics defined by the five core variables. WIN55,212-2, aspirin, rapamycin, 1400W, and LEV + BQ788 were identified compounds with the potential of effective anti-epileptic properties. Significance Our review highlights the need for consistent methodology in epilepsy research and provides a novel approach for future research. Inconsistent experimental designs hinder study comparison, slowing the progression of treatments for epilepsy. If the research community can optimize and standardize parameters such as methods of seizure induction, administration schedule, sampling time, and aniMal models, more robust meta-analysis and collaborative research would follow. Additionally, some compounds such as rapamycin, WIN 55,212-2, aspirin, 1400W, and LEV + BQ788 showed anti-epileptogenic modulation across multiple variables. We believe they warrant further study both individually and synergistically.
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Affiliation(s)
- Heather D. Ots
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Taylor Anderson
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | | | - John DelBianco
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Gordana Rasic
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Anthony Chuprin
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Zeeshan Toor
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Elizabeth Fitch
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Kripa Ahuja
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Faith Reid
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Alberto E. Musto
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, United States
- Department of Neurology, Eastern Virginia Medical School, Norfolk, VA, United States
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12
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Cramer SW, McGovern RA, Chen CC, Park MC. Clinical Benefit of Vagus Nerve Stimulation for Epilepsy: Assessment of Randomized Controlled Trials and Prospective Non-Randomized Studies. J Cent Nerv Syst Dis 2023; 15:11795735231151830. [PMID: 36654850 PMCID: PMC9841854 DOI: 10.1177/11795735231151830] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
We examined the efficacy of vagal nerve stimulation (VNS) for patients suffering from medically intractable epilepsy. Four randomized controlled trials (RCTs - 3 adult RCTs and 1 pediatric RCT) were identified in our comprehensive literature search. Across the 4 studies, high frequency VNS stimulation (frequency >20 Hz) consistently achieved a greater seizure frequency reduction (23.4-33.1%) relative to low frequency VNS stimulation (1 Hz, .6-15.2%). We identified 2 RCTs examining whether the parameters of stimulation influenced seizure control. These studies reported that VNS achieved seizure control comparable to those reported by the first 4 RCTs (22-43% seizure frequency reduction), irrespective of the parameters utilized for VNS stimulation. In terms of VNS associated morbidity, these morbidities were consistently higher in adults who underwent high frequency VNS stimulation (eg dysphonia 37-66%, dyspnea 6-25.3%). However, no such differences were observed in the pediatric population. Moreover, <2% of patients withdrew from the RCTs/prospective studies due to intolerable symptoms. To provide an assessment of how the risks and benefits of VNS impact the patient experience, 1 study assessed the well-being of enrolled patients (as a secondary end point) and found VNS was associated with an overall improvement in well-being. Consistent with this observation, we identified a prospective, non-randomized study that demonstrated improved quality of life for epilepsy patients managed with VNS and best medical practice relative to best medical practice alone. In aggregate, these RCT studies support the efficacy and benefit of VNS as a neuro-modulatory platform in the management of a subset of medically refractory epilepsy patients.
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Affiliation(s)
- Samuel W Cramer
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA,Delaware St SE, D-429 Mayo Memorial Building, MMC 96, Minneapolis, MN 55455, USA.
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA,Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA,Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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13
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Janecek JK, Brett BL, Pillay S, Murphy H, Binder JR, Swanson SJ. Cognitive decline and quality of life after resective epilepsy surgery. Epilepsy Behav 2023; 138:109005. [PMID: 36516616 DOI: 10.1016/j.yebeh.2022.109005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/04/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The objectives of this study were to examine the association between cognitive decline and quality of life (QoL) change in a large sample of individuals with drug-resistant epilepsy who underwent resective surgery and to examine whether the association between cognitive decline and QoL is differentially affected by seizure classification outcome (Engel Class 1 vs. 2-4) or side of surgery (left vs. right hemisphere). MATERIALS AND METHODS The sample comprised 224 adults (ages ≥ 18) with drug-resistant focal epilepsy treated with resective surgery who underwent comprehensive pre-operative and post-operative evaluations including neuropsychological testing and the Quality of Life in Epilepsy Inventory - 31 between 1991 and 2020. Linear mixed-effects models were fit to examine subject-specific trajectories and assess the effects of time (pre- to post-operative), cognitive decline (number of measures that meaningfully declined), and the interaction between time and cognitive decline on pre- to post-operative change in QoL. RESULTS Increases in QoL following resection were observed (B = -10.72 [SE = 1.22], p < .001; mean difference between time point 1 and time point 2 QoL rating = 8.11). There was also a main effect of cognitive decline on QoL (B = -.85 [SE = .27], p = .002). Follow-up analyses showed that the number of cognitive measures that declined was significantly associated with post-surgical QoL, (r = -.20 p = .003), but not pre-surgical QoL, (r = -.04 p = .594), and with pre-to post-surgery raw change in QoL score, (r = -.18 p = .009). A cognitive decline by time point interaction was observed, such that those who had greater cognitive decline had less improvement in overall QoL following resection (B = .72 [SE = .27], p = .009). Similar results were observed within the Engel Class 1 outcome subgroup. However, within the Engel Class 2-4 outcome subgroup, QoL improved following resection, but there was no main effect of cognitive decline or interaction between cognitive decline and time point on QoL change. There was no main effect of resection hemisphere on overall QoL, nor were there interactions with hemisphere by time, hemisphere by cognitive decline, or hemisphere by time by cognitive decline. CONCLUSIONS Quality of life improves following epilepsy surgery. Participants who had cognitive decline across a greater number of measures experienced less improvement in QoL post-operatively overall, but there was no clear pattern of domain-specific cognitive decline associated with change in QoL. Our results indicate that cognitive decline in a diffuse set of cognitive domains negatively influences post-operative QoL, particularly for those who experience good seizure outcomes (i.e., seizure freedom), regardless of the site or side of resection.
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Affiliation(s)
- Julie K Janecek
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Benjamin L Brett
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA; Department of Neurosurgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Sara Pillay
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Heather Murphy
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Sara J Swanson
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
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14
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McKnight D, Morales A, Hatchell KE, Bristow SL, Bonkowsky JL, Perry MS, Berg AT, Borlot F, Esplin ED, Moretz C, Angione K, Ríos-Pohl L, Nussbaum RL, Aradhya S, Levy RJ, Parachuri VG, Lay-Son G, de Montellano DJDO, Ramirez-Garcia MA, Benítez Alonso EO, Ziobro J, Chirita-Emandi A, Felix TM, Kulasa-Luke D, Megarbane A, Karkare S, Chagnon SL, Humberson JB, Assaf MJ, Silva S, Zarroli K, Boyarchuk O, Nelson GR, Palmquist R, Hammond KC, Hwang ST, Boutlier SB, Nolan M, Batley KY, Chavda D, Reyes-Silva CA, Miroshnikov O, Zuccarelli B, Amlie-Wolf L, Wheless JW, Seinfeld S, Kanhangad M, Freeman JL, Monroy-Santoyo S, Rodriguez-Vazquez N, Ryan MM, Machie M, Guerra P, Hassan MJ, Candee MS, Bupp CP, Park KL, Muller E, Lupo P, Pedersen RC, Arain AM, Murphy A, Schatz K, Mu W, Kalika PM, Plaza L, Kellogg MA, Lora EG, Carson RP, Svystilnyk V, Venegas V, Luke RR, Jiang H, Stetsenko T, Dueñas-Roque MM, Trasmonte J, Burke RJ, Hurst AC, Smith DM, Massingham LJ, Pisani L, Costin CE, Ostrander B, Filloux FM, Ananth AL, Mohamed IS, Nechai A, Dao JM, Fahey MC, Aliu E, Falchek S, Press CA, Treat L, Eschbach K, Starks A, Kammeyer R, Bear JJ, Jacobson M, Chernuha V, Meibos B, Wong K, Sweney MT, Espinoza AC, Van Orman CB, Weinstock A, Kumar A, Soler-Alfonso C, Nolan DA, Raza M, Rojas Carrion MD, Chari G, Marsh ED, Shiloh-Malawsky Y, Parikh S, Gonzalez-Giraldo E, Fulton S, Sogawa Y, Burns K, Malets M, Montiel Blanco JD, Habela CW, Wilson CA, Guzmán GG, Pavliuk M. Genetic Testing to Inform Epilepsy Treatment Management From an International Study of Clinical Practice. JAMA Neurol 2022; 79:1267-1276. [PMID: 36315135 PMCID: PMC9623482 DOI: 10.1001/jamaneurol.2022.3651] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Importance It is currently unknown how often and in which ways a genetic diagnosis given to a patient with epilepsy is associated with clinical management and outcomes. Objective To evaluate how genetic diagnoses in patients with epilepsy are associated with clinical management and outcomes. Design, Setting, and Participants This was a retrospective cross-sectional study of patients referred for multigene panel testing between March 18, 2016, and August 3, 2020, with outcomes reported between May and November 2020. The study setting included a commercial genetic testing laboratory and multicenter clinical practices. Patients with epilepsy, regardless of sociodemographic features, who received a pathogenic/likely pathogenic (P/LP) variant were included in the study. Case report forms were completed by all health care professionals. Exposures Genetic test results. Main Outcomes and Measures Clinical management changes after a genetic diagnosis (ie, 1 P/LP variant in autosomal dominant and X-linked diseases; 2 P/LP variants in autosomal recessive diseases) and subsequent patient outcomes as reported by health care professionals on case report forms. Results Among 418 patients, median (IQR) age at the time of testing was 4 (1-10) years, with an age range of 0 to 52 years, and 53.8% (n = 225) were female individuals. The mean (SD) time from a genetic test order to case report form completion was 595 (368) days (range, 27-1673 days). A genetic diagnosis was associated with changes in clinical management for 208 patients (49.8%) and usually (81.7% of the time) within 3 months of receiving the result. The most common clinical management changes were the addition of a new medication (78 [21.7%]), the initiation of medication (51 [14.2%]), the referral of a patient to a specialist (48 [13.4%]), vigilance for subclinical or extraneurological disease features (46 [12.8%]), and the cessation of a medication (42 [11.7%]). Among 167 patients with follow-up clinical information available (mean [SD] time, 584 [365] days), 125 (74.9%) reported positive outcomes, 108 (64.7%) reported reduction or elimination of seizures, 37 (22.2%) had decreases in the severity of other clinical signs, and 11 (6.6%) had reduced medication adverse effects. A few patients reported worsening of outcomes, including a decline in their condition (20 [12.0%]), increased seizure frequency (6 [3.6%]), and adverse medication effects (3 [1.8%]). No clinical management changes were reported for 178 patients (42.6%). Conclusions and Relevance Results of this cross-sectional study suggest that genetic testing of individuals with epilepsy may be materially associated with clinical decision-making and improved patient outcomes.
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Affiliation(s)
| | | | | | | | - Joshua L. Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City,Center for Personalized Medicine, Primary Children’s Hospital, Salt Lake City, Utah
| | - Michael Scott Perry
- Jane and John Justin Neuroscience Center, Cook Children’s Medical Center, Fort Worth, Texas
| | - Anne T. Berg
- Department of Neurology, Northwestern University—Feinberg School of Medicine, Chicago, Illinois,COMBINEDBrain, Brentwood, Tennessee
| | - Felippe Borlot
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Katie Angione
- Children’s Hospital Colorado, Aurora,Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Loreto Ríos-Pohl
- Clinical Integral de Epilepsia, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | | | | | | | - Rebecca J. Levy
- Division of Medical Genetics, Lucile Packard Children’s Hospital at Stanford University, Stanford, California
- Division of Child Neurology, Lucile Packard Children’s Hospital at Stanford University, Stanford, California
| | | | - Guillermo Lay-Son
- Genetic Unit, Pediatrics Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Miguel Angel Ramirez-Garcia
- Genetics Department, National Institute of Neurology and Neurosurgery, “Manuel Velasco Suárez,” Mexico City, Mexico
| | - Edmar O. Benítez Alonso
- Genetics Department, National Institute of Neurology and Neurosurgery, “Manuel Velasco Suárez,” Mexico City, Mexico
| | - Julie Ziobro
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Adela Chirita-Emandi
- Genetic Discipline, Center of Genomic Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timis, Romania
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu” Timisoara, Timis, Romania
| | - Temis M. Felix
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Dianne Kulasa-Luke
- NeuroDevelopmental Science Center, Akron Children’s Hospital, Akron, Ohio
| | - Andre Megarbane
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut Jerome Lejeune, Paris, France
| | | | | | | | | | - Sebastian Silva
- Child Neurology Service, Hospital de Puerto Montt, Puerto Montt, Chile
| | | | - Oksana Boyarchuk
- I.Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Gary R. Nelson
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Rachel Palmquist
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Katherine C. Hammond
- Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham
| | - Sean T. Hwang
- Zucker School of Medicine, Hofstra Northwell, Hempstead, New York
| | - Susan B. Boutlier
- ECU Physician Internal Medicine Pediatric Neurology, Greenville, North Carolina
| | | | - Kaitlin Y. Batley
- Department of Pediatrics and Neurology, UT Southwestern, Dallas, Texas
| | - Devraj Chavda
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | | | | | | | | | - James W. Wheless
- Pediatric Neurology, University of Tennessee Health Science Center, Memphis
- Le Bonheur Comprehensive Epilepsy Program & Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee
| | | | - Manoj Kanhangad
- Department of Paediatrics, Monash University, Clayton, Australia
| | | | | | | | - Monique M. Ryan
- The Royal Children’s Hospital Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Michelle Machie
- Department of Pediatrics and Neurology, UT Southwestern, Dallas, Texas
| | - Patricio Guerra
- Universidad San Sebastián, Department of Pediatrics, Medicine School, Patagonia Campus, Puerto Montt, Chile
| | - Muhammad Jawad Hassan
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Meghan S. Candee
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Caleb P. Bupp
- Spectrum Health, West Michigan Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - Kristen L. Park
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Eric Muller
- Clinical Genetics, Stanford Children’s Health Specialty Services, San Francisco, California
| | - Pamela Lupo
- Division of Neurology, Department of Pediatrics, University of Texas Medical Branch, League City
| | | | - Amir M. Arain
- Division of Epilepsy, Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Andrea Murphy
- Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana
| | | | - Weiyi Mu
- Johns Hopkins University, Baltimore, Maryland
| | | | - Lautaro Plaza
- Hospital Materno Perinatal “Mónica Pretelini Sáenz,” Toluca, México
| | | | - Evelyn G. Lora
- Dominican Neurological and Neurosurgical Society, Santo Domingo, Dominican Republic
| | | | | | - Viviana Venegas
- Clínica Alemana de Santiago, Universidad del Desarrollo, Pediatric Neurology Unit, Santiago, Chile
| | - Rebecca R. Luke
- Jane and John Justin Neuroscience Center, Cook Children’s Medical Center, Fort Worth, Texas
| | | | | | | | | | - Rebecca J. Burke
- Division of Medical Genetics, Department of Pediatrics, West Virginia University School of Medicine, Morgantown
- Division of Neonatology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown
| | - Anna C.E. Hurst
- Department of Genetics, University of Alabama at Birmingham, Birmingham
| | | | - Lauren J. Massingham
- Hasbro Children’s Hospital, Providence, Rhode Island
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Laura Pisani
- Zucker School of Medicine, Hofstra Northwell, Hempstead, New York
- Northwell Health, Medical Genetics, Great Neck, New York
| | | | - Betsy Ostrander
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Francis M. Filloux
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Amitha L. Ananth
- Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham
| | - Ismail S. Mohamed
- Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham
| | - Alla Nechai
- Neurology Department, Kiev City Children Clinical Hospital No. 1, Kyiv City, Ukraine
| | - Jasmin M. Dao
- Adult and Child Neurology Medical Associates, Long Beach, California
- Miller Children’s Hospital, Long Beach, California
| | - Michael C. Fahey
- Department of Paediatrics, Monash University, Clayton, Australia
| | - Ermal Aliu
- Department of Genetics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Stephen Falchek
- Nemours Children’s Hospital, Wilmington, Delaware
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Craig A. Press
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Lauren Treat
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Krista Eschbach
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Angela Starks
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Ryan Kammeyer
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Joshua J. Bear
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Mona Jacobson
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Veronika Chernuha
- Pediatric Neurology Institute, “Dana-Dwek” Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Kristen Wong
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Matthew T. Sweney
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - A. Chris Espinoza
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Colin B. Van Orman
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Arie Weinstock
- Division of Child Neurology, Department of Neurology, University at Buffalo, Buffalo, New York
- Oishei Children’s Hospital, Buffalo, New York
| | - Ashutosh Kumar
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Claudia Soler-Alfonso
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | | | - Muhammad Raza
- Nishtar Medical University, Multan, Punjab, Pakistan
| | | | - Geetha Chari
- SUNY Downstate Health Sciences University, Brooklyn, New York
- Kings County Hospital Center, Brooklyn, New York
| | - Eric D. Marsh
- Division of Child Neurology, Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Sumit Parikh
- Neurogenetics, Cleveland Clinic, Cleveland, Ohio
| | | | - Stephen Fulton
- Pediatric Neurology, University of Tennessee Health Science Center, Memphis
- Le Bonheur Comprehensive Epilepsy Program & Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee
| | - Yoshimi Sogawa
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Carey A. Wilson
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Guillermo G. Guzmán
- Servicio Neuropsiquiatria Infantil, Hospital San Borja Arriarán, Santiago, Chile
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15
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Cramer JA, Faught E, Davis C, Misra SN, Carrazana E, Rabinowicz AL. Quality-of-life results in adults with epilepsy using diazepam nasal spray for seizure clusters from a long-term, open-label safety study. Epilepsy Behav 2022; 134:108811. [PMID: 35816831 DOI: 10.1016/j.yebeh.2022.108811] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of seizure clusters and the use of intermittent rescue therapy for clusters on the quality of life (QoL) of patients with epilepsy has not been widely studied. The present analysis assessed QoL as a secondary endpoint among adult patients with seizure clusters enrolled in a long-term, phase 3, open-label safety study (NCT02721069) of diazepam nasal spray (Valtoco®). The QoL aspect of patients in this study has not been previously published. METHODS The 12-month safety study of diazepam nasal spray enrolled patients aged 6-65 years with seizure clusters. Adults aged ≥18 years completed the Quality of Life in Epilepsy (QOLIE)-31-P at baseline (day 0) and days 30, 150, 270, and 365. This instrument includes questions about patient health and daily activities with numeric values (1-100) assigned to responses; higher scores indicate better QoL. The QOLIE-31-P includes 7 subscales: Seizure Worry, Overall QoL, Emotional Well-Being, Energy/Fatigue, Cognitive Functioning, Medication Effects, and Social Functioning; an Overall Score is calculated as a weighted composite of the 7 subscales. Comparisons were made between subgroups of patients who had frequent (≥2) and infrequent (<2) monthly dosing of diazepam nasal spray and those whose doses were administered by the patient or a care partner. This safety study was not powered to assess efficacy endpoints; descriptive statistics were calculated across time points. In addition, safety measures, including treatment-emergent adverse events, are reported. RESULTS Seventy-two adults who responded to the QOLIE-31-P were included in the analyses. Mean QOLIE-31-P scores were stable or increased across time points. The mean total scores increased from day 0 to day 365 by 5.2 among patients providing data for ≥1 time point (follow-up group) and 2.2 among patients providing data at all time points (QOLIE all-assessments subgroup). Subscale means for Seizure Worry and Social Functioning showed the greatest numeric increase from baseline. Mean QOLIE-31-P scores were similar in all subgroups. The safety profile in the follow-up group was similar to that seen in all study adults. CONCLUSIONS Adults with refractory epilepsy who were treated with diazepam nasal spray for seizure clusters maintained or improved QOLIE subscale scores across the 12-month study period. Seizure Worry and Social Functioning subscale scores increased over time, suggesting improvement in these domains for this population with intractable epilepsy. Changes among subscale results suggest differences in sensitivity to the use of an intermittent treatment. The potential to improve patient function with treatment for seizure clusters warrants further study.
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Affiliation(s)
- Joyce A Cramer
- Consultant, Houston, TX, United States; Yale University School of Medicine, New Haven, CT, United States.
| | - Edward Faught
- Emory University School of Medicine, Atlanta, GA, United States
| | - Charles Davis
- CSD Biostatistics, Inc., Oro Valley, AZ, United States
| | | | - Enrique Carrazana
- Neurelis, Inc., San Diego, CA, United States; University of Hawaii John A. Burns School of Medicine, Honolulu, HI, United States
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16
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Girma B, Nigussie J, Tamir T, Bekele E. Public knowledge toward Epilepsy and its determinants in Ethiopia: A systematic review and meta-analysis. Epilepsy Behav 2022; 133:108764. [PMID: 35690571 DOI: 10.1016/j.yebeh.2022.108764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epilepsy is a global problem that affects all countries and people of all ages. However, the disease burden is high in low- and middle-income countries. Poor public knowledge of epilepsy increases the rate of stigma and discrimination. However, in our country, there is a scarcity of summarized evidence about the level of public knowledge toward epilepsy. Therefore, to fill this gap, conducting this review and meta-analysis has a preponderant significance. METHODS Articles were explored from PubMed, PsycINFO, Hinari, Science Direct, web of science, and African journal of online (AJOL) databases, Google, and Google scholar. For data extraction and analysis purposes, Microsoft Excel spreadsheet and STATA software version 16 were used. To write this report, we used the Preferred Reporting Items for systematic reviews and Meta-Analysis. To assess the pooledmagnitudeof public knowledge toward epilepsy, we used arandom-effects meta-analysis model. We checked the Heterogeneity by I2. To detect publication bias, Begg's test, Egger's test, and funnel plot were conducted. Furthermore, subgroup analysis was conducted. Association was expressed through a pooled odds ratio with a 95% confidence interval. RESULT Our review and meta-analysis included 9 studies with 5658 participants. The pooled magnitude of poor knowledge toward epilepsy was 48.54% [95% CI (33.57, 63.51)]. I2 was 99.4% (P < 0.01). Begg's and Egger's test results were 0.92 and 0.06, respectively. Cannot read and write OR: 2.86 [95 CI (2.04, 4.00]) and not witnessing seizure episode OR: 3.00 [95% CI (2.46, 3.66)]) were significant determinants of poor knowledge. CONCLUSION In this review and meta-analysis, around half of the participants had poor knowledge about epilepsy. Individuals who cannot read and write, and could not witness seizure episodes had more likely to have poor knowledge toward epilepsy as compared to their counterparts. Health education through different methods should be provided to the public, and our educational system should focus on this global problem. Furthermore, it is better to give training for community key informants.
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Affiliation(s)
- Bekahegn Girma
- Dilla University, College of Medicine and Health Science, Department of Nursing, Dilla, Ethiopia.
| | - Jemberu Nigussie
- Dilla University, College of Medicine and Health Science, Department of Nursing, Dilla, Ethiopia
| | - Takla Tamir
- Dilla University, College of Medicine and Health Science, Department of Nursing, Dilla, Ethiopia
| | - Etaferaw Bekele
- Dilla University, College of Medicine and Health Science, Department of Nursing, Dilla, Ethiopia
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17
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Hatami M, Sanjari Moghaddam H, Ranji Burachaloo S, Tafakhori A, Sahebi L, Vaziri S, Panahi P, Seirafianpour F, Yarahmadi M, Aghamollaii V. Psychometric evaluation of Persian version of Seizure Severity Questionnaire. Epilepsy Behav 2022; 128:108506. [PMID: 35104735 DOI: 10.1016/j.yebeh.2021.108506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Seizure severity has been increasingly gaining attention as a complementary assessment to seizure frequency for the measurement of treatment responses. This study aimed to assess the reliability and external validity and of the Persian version of the Seizure Severity Questionnaire (SSQ). METHODS The study sample was recruited from 126 patients with epilepsy who attended the neurology outpatient clinic at Imam Khomeini and Roozbeh hospitals, Tehran, Iran. The Forward-Backward technique was applied to translate the questionnaire. The reliability of SSQ was assessed by Cronbach's alpha coefficient. The external validity of SSQ was assessed by correlating SSQ scores with Quality of Life in Epilepsy Inventory-31 (QOLIE-31) subscales. RESULTS The sample comprised 63 women (50%) and 63 men (50%) aged 13-76 years. The mean scores of SSQ items ranged from 3.46 to 5.48. Distribution was skewed for all component scores, with a tendency for the item scores to concentrate toward the highest scores. Reliability for almost all domains were moderate to good, with Cronbach's alpha ranging from 0.615 to 0.770. Component B to D and total score of SSQ had weak-to-moderate inverse correlation with QOLIE-31 subscale scores. However, the result showed no significant correlation with age, sex, or education. CONCLUSION With some limitations, the Persian version of the SSQ shows relatively good reliability and content validity, supporting its use as a specific measure of seizure severity in epilepsy in Iran.
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Affiliation(s)
- Mahsa Hatami
- Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Abbas Tafakhori
- Tehran University of Medical Sciences, Neurology, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Leyla Sahebi
- Tehran University of Medical Sciences, Statistics, Iran
| | | | - Parsa Panahi
- Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Vajiheh Aghamollaii
- Tehran University of Medical Sciences, Neurology, Roozbeh Hospital, Tehran, Iran.
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18
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Gauffin H, Landtblom AM, Vigren P, Frick A, Engström M, McAllister A, Karlsson T. Similar Profile and Magnitude of Cognitive Impairments in Focal and Generalized Epilepsy: A Pilot Study. Front Neurol 2022; 12:746381. [PMID: 35095714 PMCID: PMC8790571 DOI: 10.3389/fneur.2021.746381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Cognitive impairments in epilepsy are not well-understood. In addition, long-term emotional, interpersonal, and social consequences of the underlying disturbances are important to evaluate. Purpose: To compare cognitive function including language in young adults with focal or generalized epilepsy. In addition, quality of life and self-esteem were investigated. Patients and Methods: Young adults with no primary intellectual disability, 17 with focal epilepsy and 11 with generalized epilepsy participated and were compared to 28 healthy controls. Groups were matched on age (mean = 26 years), sex, and education. Participants were administered a battery of neuropsychological tasks and carried out self-ratings of quality of life, self-esteem, and psychological problems. Results: Similar impairments regarding cognitive function were noted in focal and generalized epilepsy. The cognitive domains tested were episodic long-term memory, executive functions, attention, working memory, visuospatial functions, and language. Both epilepsy groups had lower results compared to controls (effect sizes 0.24–1.07). The total number of convulsive seizures was predictive of episodic long-term memory function. Participants with focal epilepsy reported lower quality of life than participants with generalized epilepsy. Lowered self-esteem values were seen in both epilepsy groups and particularly in those with focal epilepsy. Along with measures of cognitive speed and depression, the total number of seizures explained more than 50% of variation in quality of life. Conclusion: Interestingly, similarities rather than differences characterized the widespread cognitive deficits that were seen in focal and generalized epilepsy, ranging from mild to moderate. These similarities were modified by quality of life and self-esteem. This study confirms the notion that epilepsy is a network disorder.
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Affiliation(s)
- Helena Gauffin
- Department of Neurology, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden
| | - Anne-Marie Landtblom
- Department of Neurology, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.,Neurology Division, Clinic of Medical Specialist, Motala General Hospital, Motala, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Patrick Vigren
- Department of Neurology, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden
| | - Andreas Frick
- The Beijer Laboratory, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Maria Engström
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.,Department of Medical, Health and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anita McAllister
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Karlsson
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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19
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Soare IA, Flint I, Savic N, Puricelli F, Medjedovic J, O'Flaherty ED, James S, Longworth L. Quality of life study for caregivers of people with uncontrolled focal-onset seizures. J Med Econ 2022; 25:66-76. [PMID: 34906033 DOI: 10.1080/13696998.2021.2018871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The aim of this study was to capture and measure the impact of caregiving for an adult with uncontrolled drug-resistant focal-onset seizures (FOS) on the caregivers' quality of life (QoL), and to quantify the costs of productivity losses associated with providing informal care in this patient population. METHODS An online survey, which included the EQ-5D-5L, CarerQol-7D and the Work Productivity and Activity Impairment: Specific-Health Problem (WPAI:SHP) questionnaires, was administered to caregivers of individuals with uncontrolled drug-resistant FOS in the United Kingdom (UK), France, Spain, Germany, Italy, and Sweden. RESULTS The study included 345 caregivers. Most were males, aged between 25 and 34 years old whose caring responsibilities took between 15 and 24 h per week. The caregivers' mean EQ-5D-5L score was 0.6, with 95% confidence intervals (CI) of [0.58, 0.63], whilst the mean CarerQol-7D score was 72.61 [70.46, 74.76]. Caregivers' mental health was the most substantially affected aspect of their QoL. In addition, most caregivers reported deriving some or a lot of fulfilment out of their caregiving tasks. The WPAI:SHP showed that the mean percentage of work impairment due to caregiving responsibilities was 63%, [59.75, 66.26]. The mean annualised costs of productivity losses per caregiver were estimated at €14,872 [€11,908; €17,888]. LIMITATIONS One limitation consisted in the use of an online survey instead of a face-to-face interview. However, the medical terms were clearly explained, and examples were provided to help participants to give accurate responses. Another limitation was that the respondents self-reported as caregivers. Efforts were made to mitigate this weakness by using screener questions. CONCLUSION This study found that providing informal care for people with uncontrolled drug-resistant FOS had a negative impact on caregivers' QoL, with mental health being affected the most. However, caregivers found their role fulfilling and had support with their caring tasks.
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Affiliation(s)
| | | | - Natasa Savic
- Arvelle Therapeutics GmbH, A company of Angelini Pharma, Zug, Switzerland
| | | | - Jasmina Medjedovic
- Arvelle Therapeutics GmbH, A company of Angelini Pharma, Zug, Switzerland
| | | | - Samuel James
- Arvelle Therapeutics GmbH, A company of Angelini Pharma, Zug, Switzerland
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20
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Onder H, Ulusoy EK, Baydar C, Kiraz M, Orun MO, Kiliçarslan Z, Basol M, Tantik A. Depression, anxiety levels and sleep quality indexes among the spouses of people with epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:420-428. [PMID: 34037102 PMCID: PMC9394562 DOI: 10.1590/0004-282x-anp-2020-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Psychiatric problems and sleep disturbances are comorbidities that are frequently encountered among people with epilepsy. However, their presence among the spouses of peoples with epilepsy remains to be elucidated. OBJECTIVE The objective of this study was to evaluate the spouses of people with epilepsy (PWE), with and without a history of seizures during sleep, in terms of depression, anxiety and sleep quality. METHODS This prospective, cross-sectional study was conducted in three groups of 18 to 65-year-olds. Group 1 consisted of healthy spouses of 127 healthy volunteers without any known neurological disease; group 2 comprised spouses of 63 PWE who had no history of seizure during sleep; and group 3 consisted of spouses of 63 PWE who had a history of at least one seizure during sleep in the course of the previous year. Questionnaires seeking demographic data and the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory and Beck Anxiety Inventory were applied to all participants. RESULTS The depression scores of the group of spouses of PWE were higher than those of the control group and were higher in group 3 than in group 2 (p = 0.017). The anxiety scores of the group of spouses of PWE were significantly higher than those of the control group, but no difference in anxiety scores was found between group 2 and group 3 (p = 0.170). The mean PSQI score of group 3 was higher than that of group 2 (p = 0.029). However, regression analyses did not show any difference between these groups. CONCLUSION We found that the PSQI scores, which reflected sleep quality, were higher among the spouses of PWE who had seizures during sleep and who had more severe epilepsy.
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Affiliation(s)
- Halil Onder
- Yozgat City Hospital, Department of Neurology, Yozgat, Turkey
| | | | - Caner Baydar
- Van Training and Research Hospital, Department of Neurology, Van, Turkey
| | - Mustafa Kiraz
- Van Training and Research Hospital, Department of Neurology, Van, Turkey
| | - Muhammet Okay Orun
- Van Training and Research Hospital, Department of Neurology, Van, Turkey
| | | | - Merve Basol
- Hacettepe University Medical School, Department of Biostatistics, Ankara, Turkey
| | - Aygul Tantik
- Taksim Training and Research Hospital, Department of Neurology, Istanbul, Turkey
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21
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Impact of a pharmacist-led education and counseling interventions on quality of life in epilepsy: A randomized controlled trial. Epilepsy Res 2021; 174:106648. [PMID: 33945920 DOI: 10.1016/j.eplepsyres.2021.106648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/03/2021] [Accepted: 04/24/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The impact of epilepsy on the quality of life of the patient can be considerably high with far-reaching and life-long consequences. The goal of patient counseling and education is to achieve positive clinical outcomes and optimize the patient's health-related quality of life. OBJECTIVE To evaluate the impact of a pharmacist-led education and counselling interventions on the health-related quality of life of patients living with epilepsy. METHODS A randomized controlled trial was carried out on epilepsy patients attending the neurology/medical out-patient clinics of two tertiary hospitals. Patients in the intervention group were offered education and counselling services. The impact of the interventions on the patients' quality of life in epilepsy was evaluated using the QOLIE-10P questionnaire. The research protocol was approved by the Health Research Ethics Committees of the University of Uyo Teaching Hospital and University of Calabar Teaching Hospital (Reference numbers: UUTH/AD/S/96/VOL.XIV/571 & UCTH/HREC/33/454). RESULTS There was a statistically significant difference between the usual care (UC) and the pharmaceutical care (PC) group on the quality of life in epilepsy scores post-intervention. Comparisons between groups (UC versus PC) revealed that patients in the PC group had a significantly higher QOLIE score than those in the UC group at 3 months and 6 months - (Pre-intervention: 8.73 versus 7.91; t = 0.619; p = 0.537), (3 months: 9.74 versus 15.37; t = -3.34; p = 0.01), (6 months: 11.59 versus 17.01; t = -3.137; p = 0.01). CONCLUSION Pharmacist-led education and counselling interventions may significantly improve the quality of life of patients with epilepsy.
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22
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Gaston TE, Ampah SB, Martina Bebin E, Grayson LP, Cutter GR, Hernando K, Szaflarski JP. Long-term safety and efficacy of highly purified cannabidiol for treatment refractory epilepsy. Epilepsy Behav 2021; 117:107862. [PMID: 33667843 DOI: 10.1016/j.yebeh.2021.107862] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the safety, efficacy, and tolerability of highly purified cannabidiol (CBD) for the treatment of seizures in children and adults with treatment-resistant epilepsy (TRE) in an open-label, expanded access program (EAP). METHODS One hundred sixty-nine participants (89 children and 80 adults) with TRE received plant-derived highly purified CBD (Epidiolex® in the U.S.; 100 mg/mL oral solution) with a starting dose of 5 mg/kg/day divided twice per day and titrated to a maximum dose of 50 mg/kg/day over the study period to seizure control and tolerability and followed for up to 2 years. Seizure frequency (calendars) and severity (Chalfont Seizure Severity Score; CSSS) were collected at every study visit. Adverse Events were reported at/between study visits as required, and participants also completed Adverse Events Profile (AEP) which generates a numerical representation of AEs. Response to CBD was defined as ≥50% reduction in seizure frequency. Given non-normal distribution of seizure frequency, a log transformation was applied after which the generalized least squares regression model for longitudinal data was used. RESULTS Evidence from the adjusted model revealed a significant mean reduction in seizure frequency compared to baseline in children and adults at all time points (1 month and 1 and 2 years). Percentage of children achieving ≥50% seizure frequency reduction was 44% at month 1, and 41% at year 1, and 61% reduction at year 2, while adult responder rates were 34% at month 1, 53% at year 1, and 71% at year 2 (all P < 0.0001). CSSS showed a sustained reduction from baseline to all 3 time points. Children displayed 52% seizure reduction at month 1, a 51% reduction at year 1, and 75% reduction at year 2. Seizure reductions in adults were 60%, 81%, and 85%, respectively (all P < 0.0001). While there were no significant differences between seizure frequency reduction between children and adults at all time points, there was a significant difference in seizure severity reduction at year 1, with adults reporting greater improvement in seizure severity (P < 0.001). The most commonly reported adverse events in the study period were diarrhea, sedation, and decreased appetite. AEP revealed significant improvement from baseline at multiple time points in adults and children, and the mean AEP scores were always lower compared to baseline over the duration of the study. SIGNIFICANCE Our study provides further evidence of sustained seizure frequency and severity reduction over two years of treatment with highly purified CBD in TRE. In addition, CBD was generally well tolerated with minority of participants experiencing adverse events resulting in stopping CBD.
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Affiliation(s)
- Tyler E Gaston
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA.
| | - Steve B Ampah
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Martina Bebin
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leslie P Grayson
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathleen Hernando
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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23
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Moloney PB, Costello DJ. Unanticipated improvement in seizure control in drug-resistant epilepsy- real world observations. Seizure 2020; 84:60-65. [PMID: 33285361 DOI: 10.1016/j.seizure.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine the clinical features and anti-seizure medication (ASM) strategies associated with an unanticipated substantial improvement in seizure control in patients with drug-resistant epilepsy (DRE). METHODS This retrospective analysis of patients attending a tertiary care epilepsy clinic between 2008 and 2017 identified all patients with active DRE (at least 1 seizure per month for 6 months, despite treatment with 2 different ASMs). All treatment interventions were recorded from when DRE was first identified to the end of the study. The primary end points were seizure freedom or meaningful reduction in seizure frequency (greater than 75 %) sustained for at least 12 months after a treatment intervention. RESULTS Three hundred and twenty-two patients were included in the analysis. Overall, 10 % became seizure free following ASM adjustment and an additional 10 % had a greater than 75 % improvement in seizure control (median follow-up, 4 years). An ASM introduction was ten times more likely than an ASM dose increase to improve seizure control. Combined focal and generalized epilepsy, intellectual disability and prior treatment with more than 5 ASMs were more frequently observed in those with continued pharmacoresistance. ASM responders were more likely to have primary generalized epilepsy. Rational polytherapy (combining ASMs with different mechanisms of action) was almost ubiquitous amongst ASMs responders (95 % taking at least 2 drugs with different mechanistic targets). Of the ASM additions that heralded improved seizure control, 85 % were maintained at submaximal doses. CONCLUSIONS This retrospective analysis of a large number of 'real-world' patients provides evidence to persist with ASM trials in DRE. Early rotation of ASMs if a clinical response is not observed at a substantial dose and rational ASM polytherapy may yield better clinical outcomes in patients with DRE, although a prospective study would need to be conducted to validate these findings.
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Affiliation(s)
| | - Daniel J Costello
- Department of Neurology, Cork University Hospital, Ireland; College of Medicine and Health, University College Cork, Ireland.
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24
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Akosile CO, Anomneze JU, Okoye EC, Adegoke BOA, Uwakwe R, Okeke E. Quality of life, fatigue and seizure severity in people living with epilepsy in a selected Nigerian population. Seizure 2020; 84:1-5. [PMID: 33248424 DOI: 10.1016/j.seizure.2020.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Epilepsy, a chronic seizure disorder, can cause elevated fatigue and reduced quality of life (QOL) of the sufferers. Hence, improving QOL, seizure severity (SS) and fatigue are important areas of therapeutic interventions for people living with epilepsy (PLWE). Therefore, there is need to ascertain the levels and interrelationships among these constructs in PLWE. OBJECTIVE This study compared fatigue and QOL of PLWE with those of apparently healthy individuals (AHIs) and also determined the interrelationships between fatigue, QOL and SS in PLWE. METHOD This cross-sectional survey involved 91 PLWE and 101 AHIs consecutively recruited from purposively selected hospitals and hosting communities. The Short-form Health Survey (SF-36) questionnaire, the Fatigue Severity Scale, the Modified Fatigue Impact Scale and the Seizure Severity Questionnaire were used to evaluate QOL, fatigue severity (FS), fatigue impact (FI) and SS respectively. Data was analyzed using frequency count, proportions, mean and standard deviation, range, Chi-square test, Mann-Whitney U test and Spearman-rank order correlation. Alpha level was set at 0.05. RESULTS PLWE had significantly lower QOL compared to AHIs (U = 3057.00;p < 0.01). The two groups however experienced similar fatigue severity, but PWE suffered greater fatigue impact (U = 2798.00;p < 0.01). Significant relationships existed among FI, FS, SS and QOL in PLWE (p < 0.01). CONCLUSION Compared with AHIs, PLWE had poorer QOL, similar FS, and higher FI. QOL of PLWE was negatively associated with SS, FI and FS. Clinical interventions geared towards minimizing seizure, severity and impact of fatigue may improve the QOL of PLWE.
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Affiliation(s)
- Christopher Olusanjo Akosile
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria.
| | - John Uche Anomneze
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria.
| | - Emmanuel Chiebuka Okoye
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria.
| | | | - Richard Uwakwe
- Department of Psychiatry, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria.
| | - Emeka Okeke
- Rise Clinic Nigeria and Global Health Initiative Adazi-ani, Anambra State, Nigeria.
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Cramer SW, McGovern RA, Wang SG, Chen CC, Park MC. Resective epilepsy surgery: assessment of randomized controlled trials. Neurosurg Rev 2020; 44:2059-2067. [PMID: 33169227 DOI: 10.1007/s10143-020-01432-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
Epilepsy is the most common form of chronic neurologic disease. Here, we review the available randomized controlled trials (RCTs) that examined the efficacy of resective epilepsy surgery in select patients suffering from medically intractable epilepsy (defined as persistent epilepsy despite two or more antiepileptic drugs [AEDs]). Three RCTs (two adult RCTs and one pediatric RCT) consistently supported the efficacy of resective surgery as treatment for epilepsy with semiology localized to the mesial temporal lobe. In these studies, 58-100% of the patients who underwent resective surgery achieved seizure freedom, in comparison to 0-13% of medically treated patients. In another RCT, the likelihood of seizure freedom after resective surgery was independent of the surgical approach (transSylvian [64%] versus subtemporal [62%]). Two other RCTs demonstrated that hippocampal resection is essential to optimize seizure control. But, no significant gain in seizure control was achieved beyond removing 2.5 cm of the hippocampus. Across RCTs, minor complications (deficit lasting < 3 months) and major complications (deficit > 3 months) ranged 2-5% and 5-11% respectively. However, nonincapacitating superior subquadrantic visual-field defects (not typically considered a minor or major complication) were noted in up to 55% of the surgical cohort. The available RCTs provide compelling support for resective surgery as a treatment for mesial temporal lobe epilepsy and offer insights toward optimal surgical strategy.
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Affiliation(s)
- Samuel W Cramer
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA.
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA.,Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA
| | - Sonya G Wang
- Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA.,Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA
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Associations between seizure severity change and patient characteristics, changes in seizure frequency, and health-related quality of life in patients with focal seizures treated with adjunctive eslicarbazepine acetate: Post hoc analyses of clinical trial results. Epilepsy Behav 2020; 112:107312. [PMID: 32801102 DOI: 10.1016/j.yebeh.2020.107312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/28/2020] [Indexed: 11/24/2022]
Abstract
The relationships between seizure severity change and patient characteristics, changes in seizure frequency, and health-related quality of life (HRQoL) may be important for determining the overall impact of medication therapy on patients with epilepsy. The objectives of these post hoc analyses of the global Phase III 093-0304 trial (NCT00988429, Study 304) of adjunctive eslicarbazepine acetate (ESL) in patients with refractory focal (partial-onset) seizures (FS) were to evaluate associations between seizure severity change, measured by the Seizure Severity Questionnaire (SSQ), and 1) patient characteristics, 2) seizure frequency change, standardized as the seizure frequency (SSF) per 28-day period, and 3) change in HRQoL, evaluated by the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) and the Montgomery-Åsberg Depression Rating Scale (MADRS). The analyses were conducted on the per-protocol population (PPP) of patients who were randomized to a placebo arm (n = 188) or an ESL-active group that included treatment with adjunctive ESL 800 mg once daily (QD; n = 184) or adjunctive ESL 1200 mg QD (n = 175). General linear models (GLM) were used to measure the association between SSQ change and patient baseline characteristics or percentage change in the SSF from baseline. Associations between changes in the SSQ and changes in the QOLIE-31 and MADRS were examined using GLM with patient baseline characteristics as covariates. Subgroup analyses were performed for patients in the ESL-active group and those treated with ESL 800 mg or ESL 1200 mg. Minimal clinically important difference (MCIDs) thresholds were used to assess improvements in SSQ scores. The analyses included 547 per-protocol patients. Patients using 1 antiepileptic drug (AED) at baseline had greater improvements in the SSQ compared with those receiving 2 AEDs (P = 0.0606). Treatment with ESL 1200 mg was significantly associated with clinically meaningful improvements in the SSQ (P = 0.0005). The SSQ improvements were significantly associated with an SSF reduction of ≥75%, compared with no reduction (P < 0.0001). In the PPP and the ESL-active group, SSQ improvements were significantly associated with improvements in QOLIE-31 Total Score (TS; P < 0.0001) and the Seizure Worry (SW; P < 0.0001) and Social Functioning (SF; P = 0.0030) subscales. In the ESL 1200 mg subgroup, SSQ improvements were significantly associated with improvements in QOLIE-31 TS (P < 0.0001) and the SW (P < 0.0001) and Energy/Fatigue (EF; P = 0.0007) subscales. In the ESL 800 mg subgroup, improvements in the SSQ were significantly associated with improvements in QOLIE-31 TS (P = 0.0362) and the SW (P = 0.0241) subscale. There was no significant association between changes in the SSQ and changes in the MADRS in patients treated with ESL. These findings demonstrated that in this clinical trial population, adding ESL to baseline AED therapy had utility for decreasing seizure severity and improving HRQoL. There were no significant associations between changes in seizure severity and changes in depressive symptoms in patients with FS.
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Natural history of generalized motor seizures: A retrospective analysis. Seizure 2020; 80:109-112. [PMID: 32563169 DOI: 10.1016/j.seizure.2020.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/07/2020] [Accepted: 05/22/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This study aims to characterize the natural history of generalized motor seizures through longitudinal stratification of patient-reported clinical seizures into high, medium and low rates of generalized motor seizures (also known as generalized tonic-clonic seizures or GTCs). METHODS From 2007 to 2018, 1.4 million seizures were recorded by 12,402 SeizureTracker.com users that met inclusion/exclusion criteria. The number of GTCs per year since the first seizure diary entry was calculated for each user and categorized as: Low (0 GTCs/year), Medium (1-2 GTCs/year), or High (>3 GTCs/year) GTC rates. RESULTS Kaplan-Meier survival curves for the time until exiting the initial category were computed. There was a global difference between risk groups (p < 0.01). Further pairwise log rank tests revealed a difference between each pair of risk groups (p < 0.01). At 3 years, 40.8% of people initially presenting with high GTC rates remained in their initial category, while 77.3% of people initially presenting with low GTC rates remained in their initial category. CONCLUSION A patient with a low rate of GTCs is likely to remain at low risk for future GTCs, whereas higher GTC rate patients (at least one GTC/year) may leave their initial risk stratification. Thus, yearly re-assessment may be prudent when considering risk of further GTCs. Given the association between higher yearly rates of GTCs with increased SUDEP risk and morbidity in epilepsy, further validation of these findings is important for prognostication.
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Huber-Mollema Y, Oort FJ, Lindhout D, Rodenburg R. Well-being of mothers with epilepsy with school-aged children. Epilepsy Behav 2020; 105:106966. [PMID: 32146338 DOI: 10.1016/j.yebeh.2020.106966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of the study was to examine different aspects of well-being in mothers with epilepsy with school-aged children. METHODS In an observational study, mothers, identified from the European Registry of Antiepileptic Drugs and Pregnancy database in the Netherlands, completed questions on epilepsy, the impact of epilepsy on daily functioning, quality of life, behavioral problems, and parenting stress. Descriptive analyses were performed to examine the prevalence of behavioral problems and the impact of epilepsy on different aspects of the mother's daily functioning and family life. We subsequently investigated which factors contributed most to the impact of maternal epilepsy using regression analyses. RESULTS One hundred fifty-six (46%) of the 342 invited mothers with epilepsy participated. The majority (89%) had low epilepsy severity, with well-controlled seizures. Internalizing problems within the borderline or clinical range were reported by 23% of the mothers. Behavioral problems were significantly correlated with epilepsy severity (r = 0.26, p = .002), impact of epilepsy on daily functioning (r = 0.32, p < .001), and quality of life (r = -0.52, p < 01). Quality of life was in general good (mean = 8, standard deviation [SD] = 1), with low impact of epilepsy. Epilepsy affected mostly maternal self-confidence, work, and general health. Mothers indicated to experience no to little impact of epilepsy on the relationship with their children, partner, or family. Regression analyses showed that epilepsy severity (1.0, 95% confidence interval [CI]: 0.4 to 1.6; p = .002) and quality of life (-1.3, CI: -2.3 to -0.4; p = .007) were significant contributors to the impact of epilepsy on daily functioning, while other factors (maternal education, family type, behavioral problems, and parenting stress) were nonsignificant. DISCUSSION The current study shows that mothers with epilepsy generally fared well. Epilepsy negatively impacted the lives of some mothers, though. As maternal well-being is of importance for mother-child interaction and child development, clinicians should be aware of the impact of epilepsy on maternal psychosocial outcomes and family life of women with epilepsy.
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Affiliation(s)
- Yfke Huber-Mollema
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Frans J Oort
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Dick Lindhout
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Department of Genetics, University Medical Center Utrecht, the Netherlands
| | - Roos Rodenburg
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, the Netherlands. H.-
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Aljafen BN, Alomar M, Abohamra N, Alanazy M, Al-Hussain F, Alhumayyd Z, Mohammad Y, Muayqil T. Knowledge of and attitudes toward epilepsy surgery among neurologists in Saudi Arabia. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2020; 25:43-49. [PMID: 31982894 PMCID: PMC8015624 DOI: 10.17712/nsj.2020.1.20190051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives: To investigate the levels of knowledge and attitudes toward epilepsy surgery among neurologists in Saudi Arabia and evaluate the factors that affect the physicians’ knowledge and attitudes. Methods: A quantitative observational cross-sectional study conducted at King Saud University Medical City, Riyadh. The data were collected using a newly developed, self-administered online questionnaire. The questionnaire contained 3 sections: demographic information, knowledge, and attitudes which then sent to neurologist in Saudi Arabia from December 2016 to March 2017. Results: A total of 106 neurologists met our inclusion criteria. Eighty percent of the participants had at least one epilepsy center in their city, and 78% indicated that they had access to adequate expertise and resources to enable the appropriate selection of epilepsy surgical candidates. Only 57.5% of the neurologists had a sufficient level of knowledge regarding epilepsy surgery. Neurologists with higher level of knowledge referred more patients to EMU and discussed epilepsy surgery more often with their patients. Overall, more than half of the neurologists (52.8%) had a positive attitude toward epilepsy surgery. There was a significantly positive correlation between the scores of knowledge and attitude (p<0.001). Conclusion: Neurologists in Saudi Arabia appear to have moderate knowledge of and positive attitudes toward epilepsy surgery. The place of the last neurology certificate, type of practicing hospital, and access to expertise and resources, affected their knowledge. Adequate knowledge was positively correlated with attitude.
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Affiliation(s)
- Bandar N Aljafen
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Onder H. Letter regarding the article 'Evaluation of sleep quality in spouses of people with epilepsy'. Epilepsy Behav 2019; 98:285-286. [PMID: 31182395 DOI: 10.1016/j.yebeh.2019.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Halil Onder
- Neurology Clinic, Yozgat City Hospital, Yozgat, Turkey.
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de Oliveira J, Drabowski B, Rodrigues S, Maciel R, Moraes M, Cota V. Seizure suppression by asynchronous non-periodic electrical stimulation of the amygdala is partially mediated by indirect desynchronization from nucleus accumbens. Epilepsy Res 2019; 154:107-115. [DOI: 10.1016/j.eplepsyres.2019.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/17/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Kaddumukasa M, Mugenyi L, Lhatoo S, Sewankambo N, Blixen C, Sajatovic M, Katabira E. Seizure severity is associated with poor quality of life in people living with epilepsy (PLWE) in Uganda: A cross-sectional study. Epilepsy Behav 2019; 96:104-108. [PMID: 31125798 PMCID: PMC6597271 DOI: 10.1016/j.yebeh.2019.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/26/2022]
Abstract
RATIONALE There is a paucity of information about the association of seizure severity and quality of life (QoL) in people living with epilepsy (PLWE) in sub-Saharan Africa. We evaluated the relationship between seizure severity and health-related quality of life (HRQoL) of patients with epilepsy being followed up in an outpatient neurology clinic in urban central Uganda. METHODS Forty-eight PLWE who met the study inclusion criteria were enrolled. The study questionnaire was comprised of the Chalfont Seizure Severity Scale (CSSS) and the Quality of Life Inventory in Epilepsy (QOLIE-31). Spearman's rank correlation coefficient was used to determine the association between seizure severity and QoL score. RESULTS The median age of the study participants was 25 years, with median age (interquartile range (IQR)) of epilepsy onset of 12 (6-18) years. Over 57.4% of the study participants were unemployed. The mean (standard deviation (SD)) of QOLIE-31 and Seizure Severity Score was 62.5 (14.5) and 62.4 (1.6), respectively. There was no gender difference in the seizure severity scores (p = 0.451). An inverse relationship existed between seizure severity and the total QOLIE-31 score (Spearman's rank correlation coefficient, r = -0.48, p = 0.001), and seizure worry (r = -0.31, p = 0.030). CONCLUSIONS In this Ugandan sample, seizure severity is unacceptably high and directly impacts the life of PLWE. Interventions that reduce seizure severity are urgently needed in our settings to reduce seizures and improve the QoL in PLWE.
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Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Levicatus Mugenyi
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - Samden Lhatoo
- Department of Neurology, The University of Texas, Health Science Center at Houston, 6431 Fannin Street - Suite MSB 7.044, Houston, TX 77030, USA.
| | - Nelson Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
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Gaston TE, Szaflarski M, Hansen B, Bebin EM, Szaflarski JP. Quality of life in adults enrolled in an open-label study of cannabidiol (CBD) for treatment-resistant epilepsy. Epilepsy Behav 2019; 95:10-17. [PMID: 31003195 DOI: 10.1016/j.yebeh.2019.03.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
Treatment-resistant epilepsy (TRE) is associated with low quality of life (QOL). Cannabidiol (CBD) may improve QOL, but it is unclear if such improvements are independent of improvements in seizure control. Our aim was to compare QOL at baseline and after 1 year of treatment with CBD. We hypothesized that QOL would improve independent of changes in seizure frequency (SF) or severity, mood, or adverse events. We assessed QOL using Quality of Life in Epilepsy-89 (QOLIE-89) in an open-label study of purified CBD (Epidiolex®) for the treatment of TRE. All participants received CBD, starting at 5 mg/kg/day and titrated to 50 mg/kg/day in increments of 5 mg/kg/day. We collected QOLIE-89 in adult participants at enrollment and after 1 year of treatment, or at study exit if earlier. We analyzed if the change in QOLIE-89 total score could be explained by the change in SF, seizure severity (Chalfont Seizure Severity Scale, CSSS), mood (Profile of Moods States, POMS), or adverse events (Adverse Event Profile, AEP). Associations among the variables were assessed using bivariate tests and multiple regression. Fifty-three participants completed enrollment and follow-up testing, seven at study termination. Mean QOLIE-89 total score improved from enrollment (49.4 ± 19) to follow-up (57 ± 21.3; p = .004). We also saw improvements in SF, POMS, AEP, and CSSS (all p ≤ .01). Multivariable regression results showed QOLIE-89 at follow-up associated with improvements in POMS at follow-up (p = .020), but not with AEP, CSSS, or SF (p ≥ .135). Improvement in QOL after treatment with CBD is associated with better mood but not with changes in SF, seizure severity, or AEP. Cannabidiol may have beneficial effects on QOL and mood that are independent of treatment response.
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Affiliation(s)
- Tyler E Gaston
- Department of Neurology, Division of Epilepsy, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
| | - Magdalena Szaflarski
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Hansen
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Martina Bebin
- Department of Neurology, Division of Epilepsy, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, Division of Epilepsy, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Jędrzejczak J, Majkowska-Zwolińska B, Ryglewicz D, Nagańska E, Mazurkiewicz-Bełdzińska M. Recommendations of the Polish Society of Epileptology for the treatment of epileptic seizure in adult patients in Poland: an update. JOURNAL OF EPILEPTOLOGY 2019. [DOI: 10.21307/jepil-2019-002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Faught E. The Cost of the Second Seizure: Rethinking the Treatment Decision. Epilepsy Curr 2019; 19:88-90. [PMID: 30955429 PMCID: PMC6610411 DOI: 10.1177/1535759719835367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Antiepileptic Drug Treatment After an Unprovoked First Seizure: A Decision Analysis Bao EL, Chao LY, Ni P, et al. Neurology. 2018;91(15):e1429-e1439. doi:10.1212/WNL.0000000000006319 Objective: To compare the expected quality-adjusted life-years (QALYs) in adult patients undergoing immediate versus deferred antiepileptic drug (AED) treatment after a first unprovoked seizure. Methods: We constructed a simulated clinical trial (Markov decision model) to compare immediate versus deferred AED treatment after a first unprovoked seizure in adults. Three base cases were considered, representing patients with varying degrees of seizure recurrence risk and effect of seizures on quality of life (QOL). Cohort simulation was performed to determine which treatment strategy would maximize the patient’s expected QALYs. Sensitivity analyses were guided by clinical data to define decision thresholds across plausible measurement ranges, including seizure recurrence rate, effect of seizure recurrence on QOL, and efficacy of AEDs. Results: For patients with a moderate risk of recurrent seizures (52.0% over 10 years after first seizure), immediate AED treatment maximized QALYs compared to deferred treatment. Sensitivity analyses showed that for the preferred choice to change to deferred AED treatment, key clinical measures needed to reach implausible values were 10-year seizure recurrence rate ≤38.0%, QOL reduction with recurrent seizures ≤0.06, and efficacy of AEDs on lowering seizure recurrence rate ≤16.3%. Conclusion: Our model determined that immediate AED treatment is preferable to deferred treatment in adult first-seizure patients over a wide and clinically relevant range of variables. Furthermore, our analysis suggests that the 10-year seizure recurrence rate that justifies AED treatment (38.0%) is substantially lower than the 60% threshold used in the current definition of epilepsy.
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Zhu XR, Zhao T, Gu H, Gao YJ, Wang N, Zhao P, Chen YN, Han X, He GN, Li MM, Ma BQ, Yang SJ. High risk of anxiety and depression in caregivers of adult patients with epilepsy and its negative impact on patients' quality of life. Epilepsy Behav 2019; 90:132-136. [PMID: 30530135 DOI: 10.1016/j.yebeh.2018.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of this study was to assess the anxiety and depression of caregivers of adult patients with epilepsy (PWE) and evaluate its effect on patient quality of life (QOL). METHOD One hundred sixty pairs of adult PWE and their caregivers were enrolled in our study. Quality of life in adult PWE was evaluated with the Quality of Life in Epilepsy Inventory-31 scale (QOLIE-31). Symptoms of anxiety and depression in caregivers were assessed with the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) respectively. Correlation and stepwise multiple liner regression analyses were used as statistical analysis. RESULTS Of the caregivers, 41 (31.30%) had anxiety symptoms (HAM-A scores > 6) and 44 (33.59%) had depression symptoms (HAM-D scores > 6). Caregiver anxiety was significantly associated with poorer adult PWE QOL scores in four of the seven subscales and the QOLIE-31 total score. Caregiver depression was significantly associated with poorer adult PWE QOL in all seven subscales as well as the QOLIE-31 total score. Caregiver depression was an independent predictor of the QOLIE-31 total score and five subscales: seizure worry, emotional wellbeing, energy/fatigue, cognitive, and medication effects. CONCLUSION Caregivers of adult PWE are at high risk of experiencing anxiety and depression. Caregiver psychological status, especially depression, was an independent predictor of poorer QOL for adult PWE.
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Affiliation(s)
- Xue-Rui Zhu
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Ting Zhao
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Hao Gu
- Department of Neurology, Luohe Second People's Hospital, Henan Province, Luohe 462000, China
| | - Ya-Juan Gao
- Department of Pediatric, Peking University Third Hospital, Beijing 100089, China
| | - Na Wang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Pan Zhao
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Ya-Nan Chen
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
| | - Gui-Nv He
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Ming-Min Li
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Bing-Qian Ma
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Shi-Jun Yang
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
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Arinzechi EO, Ogunrin OA, Nwosu CM, Nwani PO, Enwereji KO, Asomugha LA, Dimkpa U. Seizure frequency and risk of cognitive impairment in people living with epilepsy in a sub-urban community in South Eastern Nigeria. J Clin Neurosci 2018; 59:98-105. [PMID: 30446372 DOI: 10.1016/j.jocn.2018.10.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 09/30/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
Abstract
This study is aimed at assessing the impact of seizure frequency on the cognitive performance of epileptic adult patients in a rural community in South Eastern Nigeria. A total of 51 patients with epilepsy (33 males and 18 females) with a mean age of 30.7 ± 12.1 years and 51 age and sex matched controls participated in this study. The cognitive performances of the people with epilepsy and controls were assessed using the Community Screening Interview for Dementia (CSID) and the computerized cognitive assessment test battery, the FePsy. The control group performed better in almost all the neurocognitive tests compared with the low seizure frequency (LSF) and high seizure frequency (HSF) groups. Analysis of covariance revealed that patients with LSF performed better (p = 0.04) in visual reaction time - dominant hand (VRT-D) compared with the HSF group. There was lack of significant differences in mean total CSID scores and mean sub-total scores for language, memory, orientation, attention, constructional praxis, auditory reaction time-dominant hand and non-dominant hand, VRT - non-dominant hand and figure recognition. HSF patients indicated significantly greater prevalence (80% vs. 20%; p = 0.020) and risk (OR, 8.0; 95% CI, 1.8-33.8)) of memory impairment, but not in the other neurocognitive domains compared with the LSF group. In conclusion, the present study indicated that adults with epilepsy performed poorly in a wide range of neurocognitive variables compared with the controls. However, no significant adverse effects of high seizure frequency were observed on almost all the neurocognitive variables.
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Affiliation(s)
- Eugene O Arinzechi
- Department of Medicine, Neurology Unit, Nnamdi Azikiwe University Teaching, Nnewi, Nigeria
| | - Olubunmi A Ogunrin
- Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Cosmas M Nwosu
- Department of Medicine, Neurology Unit, Nnamdi Azikiwe University Teaching, Nnewi, Nigeria
| | - Paul O Nwani
- Department of Medicine, Neurology Unit, Nnamdi Azikiwe University Teaching, Nnewi, Nigeria
| | - Kelechi O Enwereji
- Department of Medicine, Neurology Unit, Nnamdi Azikiwe University Teaching, Nnewi, Nigeria
| | - Lasbrey A Asomugha
- Department of Medicine, Neurology Unit, Nnamdi Azikiwe University Teaching, Nnewi, Nigeria
| | - Uchechukwu Dimkpa
- Department of Human Physiology, Faculty of Basic Medical Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria.
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Henok A, Lamaro T. Knowledge about and Attitude towards Epilepsy among Menit Community, Southwest Ethiopia. Ethiop J Health Sci 2018; 27:47-58. [PMID: 28458490 PMCID: PMC5390228 DOI: 10.4314/ejhs.v27i1.7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nearly 80% of the people with epilepsy are found in developing countries, where epilepsy remains a major public health problem, not only because of its health implications but also for its social, cultural, psychological and economic effects. The objective of this study was to assess knowledge and attitude of Menit community in Benchi-Maji Zone as regards epilepsy. METHODS The study was conducted in Menit Goldia Province, one of the provinces of Bench-Maji Zone. Community based descriptive cross-sectional study was employed. Households were selected by using systematic sampling technique. Data was collected through pretested interviewer administered questionnaire. Data was cleaned, coded and entered in to EPI data version 3.1. The data was cleaned and transported into SPSS for analysis. RESULTS Among the study participants, 808(97.1%) ever heard about epilepsy, 85.3% reported that epilepsy is a mental disease where as 40.6%, 49% and 49.4% respectively believed that it is hereditary, contagious, and God's curse. Among the respondents, 252(30%) think that epileptics should be isolated from the community, 387(46.1%) and 336(40%) do not want to shake hands with epileptics and keep their children away from epileptic patients respectively. In this study, 85.6% and86.8% of the respondents were not knowledgeable about and had negative attitude towards epilepsy respectively. Ethnicity and educational status were significantly associated with knowledge and attitude. The FGD participants noted that the disease is God's curse, and they lacked knowledge about the cause of epilepsy. CONCLUSION The study participants' level of knowledge about and attitude towards epilepsy was not satisfactory. Thus, it needs attention from concerned bodies.
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Affiliation(s)
- Andualem Henok
- Department of Public Health, Mizan-Tepi University, Mizan, Ethiopia
| | - Tafesse Lamaro
- Department of Nursing, Mizan-Tepi University, Mizan, Ethiopia
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Liu H, Xu X. Influence of adjunctive lacosamide in patients with seizures: a systematic review and meta-analysis. Int J Neurosci 2017; 128:670-676. [PMID: 29172828 DOI: 10.1080/00207454.2017.1408619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Hongju Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoli Xu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
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Vaiman M, Heyman E, Lotan G. Neurological results of the modified treatment of epilepsy by stimulation of the vagus nerve. Childs Nerv Syst 2017; 33:2017-2022. [PMID: 28689344 DOI: 10.1007/s00381-017-3490-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The vagus nerve stimulation (VNS) is used for treatment of drug-resistant epilepsy but laryngeal side effects are common. We tried to improve VNS by modifying the implantation procedure. The aim was to reduce the rate of side effects that have prevented using VNS to its full capacity. METHODS We operated on 74 pediatric patients for VNS device implantation using a modified surgical protocol incorporating lower neck incision for electrode placement and 36 patients who were operated by standard technique were used for control group. We retrospectively analyzed reduction in frequency of seizures, reduction in severity of seizures (assessed by the shortened Ictal/post-ictal subscale of the Liverpool Seizure Severity Scale that included falling to the ground, postictal headache and sleepiness, incontinence, tongue biting, and injury during attack). RESULTS Using the new implantation technique, side effects related directly to VNS therapy occurred in six cases (8.1%) showing statistically sound improvement over the standard implantation technique (p ˂ 0.05). To achieve good results, the maximum stimulation (3.5 mA) was used in 24 patients (32.4%), with no laryngeal side effects detected. Twelve patients (16.2%) were seizure-free after the first year of VNS treatment. 74.3% of patients experienced a 50% reduction in seizure frequency and improved ictal or postictal activity. CONCLUSION To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique may be modified, and lower neck incision could be used. A low rate of laryngeal side effects allows using the VNS device to its full electrical capacity.
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Affiliation(s)
- Michael Vaiman
- Department of Otolaryngology - Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 33 Shapiro Street, 59561, Bat Yam, Israel.
| | - Eli Heyman
- Pediatric Epilepsy Service, Pediatric Neurology Department, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Lotan
- Department of Pediatric Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ives-Deliperi V, Butler JT. Quality of life one year after epilepsy surgery. Epilepsy Behav 2017; 75:213-217. [PMID: 28867569 DOI: 10.1016/j.yebeh.2017.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of surgery for medically intractable epilepsy was to achieve seizure freedom and improve overall quality of life (QOL) in patients. This investigation looked at changes in QOL one year after epilepsy surgery and the relationship of changes to mood, language, and seizure outcomes. METHOD Depressive symptoms, QOL, and naming were measured in 25 patients with temporal lobe epilepsy before and one year after dominant temporal lobe resection. The Quality of Life in Epilepsy-89 (QOLIE-89), Beck Depression Inventory II (BDI-II), and Boston Naming Test (BNT) were used, respectively, and seizure outcome was reported according to the Engel classifications. Minimum clinically important differences (MCID) and reliable change indices (RCI) were used to assess the proportion of patients who achieved meaningful improvement or worsening in the respective areas of functioning, and the relationship between outcomes was evaluated. Changes on the 17 individual items of the QOLIE-89 were also assessed. RESULTS Overall, there was a significant improvement in QOL, reduction in depressive symptoms, and decline in naming one year after surgery. Positive clinically important improvement in QOL was achieved in 76% of patients, meaningful reduction of depressive symptoms was achieved in 20%, and clinically important naming declines were observed in 48% of the cohort. Sixteen patients were seizure-free one year after surgery, but there was no significant correlation between changes in QOL and seizure outcome, depressive symptoms, or naming. CONCLUSION The results in the reported cohort of patients showed that surgical treatment of temporal lobe epilepsy in the dominant hemisphere resulted in clinically meaningful improvement in overall QOL and declines in naming but no significant reduction of mood disturbance.
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Affiliation(s)
| | - James Thomas Butler
- Department of Neurology, University of Cape Town, South Africa; Department of Neurology, University of Stellenbosch, South Africa
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Abstract
The incidence and prevalence of adults diagnosed with epilepsy is higher compared to those diagnosed in childhood, yet the experience of living with adult-onset epilepsy has rarely been examined. Hence, the current study took a phenomenological approach to examining the experience of living with epilepsy following diagnosis in adulthood. Semi-structured interviews were conducted with 39 people from across the UK, diagnosed with epilepsy between the ages of eighteen and sixty, at two points in time, six months apart. Phenomenological analysis identified three central themes: the unpredictability of seizure occurrence; the ripple effect; and re-evaluating the future. Despite the accepted consensus in the epilepsy literature that living and coping with epilepsy becomes more difficult the older a person is diagnosed, the current findings indicated that this is inadequate. Rather, it is more suitable to consider that those living with adult-onset epilepsy have a specific experience of the condition and particular support needs, given that they once lived their lives as people without epilepsy.
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Affiliation(s)
- Stephanie Kılınç
- School of Social Science, Business and Law, Teesside University, Borough, Road, Middlesbrough TS1 3BX, UK.
| | - Anna van Wersch
- School of Social Science, Business and Law, Teesside University, Borough, Road, Middlesbrough TS1 3BX, UK
| | | | - Alison Guy
- School of Social Science, Business and Law, Teesside University, Borough, Road, Middlesbrough TS1 3BX, UK
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The influence of levetiracetam on psychosocial and behavioral functioning in children: A case-control and follow-up study. Epilepsy Behav 2017; 72:39-42. [PMID: 28575765 DOI: 10.1016/j.yebeh.2017.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/10/2017] [Accepted: 04/25/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Levetiracetam, a widely used antiepileptic drug in children, has been associated with psychosocial and behavioral problems, which are also influenced by epilepsy variables, including duration or seizure frequency. PURPOSE The objective of this study is to investigate the frequency and timing of treatment-emergent psychosocial and behavioral problems in children receiving levetiracetam, irrespective of seizure variables which are possible confounders. METHODS A prospective, case-control study with a 3-month follow-up was conducted. Consecutive children aged 6 to 16years with new-onset partial seizures were included in case of starting treatment with either levetiracetam or valproic acid. Psychosocial and behavioral functioning were assessed using a set of standardized questionnaires including Strengths and Difficulties Questionnaire (SDQ) and Children's Depression Inventory (CDI) at baseline, 1 and 3-month follow-up. Patients' baseline scores were compared to healthy subjects. The difference in the follow-up SDQ and CDI scores was evaluated in patients receiving levetiracetam and valproic acid. RESULTS A total of 101 participants were analyzed; 32 patients in levetiracetam group, 19 patients in valproic acid group and 50 healthy controls. Baseline SDQ and CDI scores were not statistically different between patients and healthy subjects (p>0.05). No statistically significant difference was observed in CDI, total and subscale SDQ scores between patients receiving levetiracetam or valproic acid during the study period (p>0.05). A girl aged 15years receiving levetiracetam had a CDI score of 18 without suicidal ideation at baseline. She developed suicidal ideation and depression, which resolved after switching of levetiracetam to valproic acid, at the 1-month follow-up. No other psychiatric or behavioral side-effects were observed in other patients. CONCLUSION Psychosocial and behavioral side-effects of levetiracetam treatment are not frequent and they don't emerge in most of children at lower doses. At this dose, and after 3months, using these specific instruments, we did not observe any difference between the valproic acid and levetiracetam treatment groups.
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Saha R, Mohapatra S, Kar S, Tekkalaki B, Anand K. Causative factors and phenomenology of depression in EPILEPSY—A review. INTERNATIONAL JOURNAL OF EPILEPSY 2017; 04:070-078. [DOI: 10.1016/j.ijep.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
AbstractIt is a known fact that depression is the one of the leading causes of years lived with disability and the fourth leading cause of disability-adjusted life-years worldwide. Depression is often under-recognized among patients of epilepsy due to lack of awareness of depressive symptoms. Due to improper management of depression in epileptic patients, it can interfere with treatment outcomes and hence can impair the quality of life. Undermanaged depression in epilepsy is generally associated with work absenteeism and direct medical costs. Electronic JR_liographic databases like PubMed and Google Scholar were searched using the format “(depression, epilepsy and symptoms)”. Cross-linked searches were made taking the lead from key articles. Recent articles and those exploring the etiological factors & symptomatic presentation of depression were focused upon. The main purpose of this review was to study the causative association between epilepsy and depression and to discuss the varied symptomatic presentation.
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Affiliation(s)
- Rahul Saha
- Department of Psychiatry, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Sujit Kar
- Department of Psychiatry, KGMU, Lucknow, UP, India
| | - Bheemsain Tekkalaki
- Department of Psychiatry, Navodaya Medical College, Raichur, Karnataka, India
| | - K. Anand
- Department of Neurology, PGIMER, Dr RML Hospital, N Delhi, India
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Lin CY, Chen H, Pakpour AH. Correlation between adherence to antiepileptic drugs and quality of life in patients with epilepsy: A longitudinal study. Epilepsy Behav 2016; 63:103-108. [PMID: 27588360 DOI: 10.1016/j.yebeh.2016.07.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study aimed to investigate whether the score of self-reported medication adherence using the Medication Adherence Report Scale (MARS-5) correlates with the serum level of antiepileptic medication, as well as whether the MARS-5 score can predict the quality of life (QoL) in patients with epilepsy. METHODS A longitudinal study was carried out. The patients with epilepsy who were prescribed a minimum of one antiepileptic drug were recruited (n=807). Each participant completed a background information sheet and the MARS-5 at baseline, followed by the Liverpool Seizure Severity Scale (LSSS) and Quality of Life in Epilepsy (QOLIE-31) questionnaire at 18-month follow-up. In addition, the serum level of antiepileptic medications was measured at the follow-up. RESULTS The MARS-5 score was negatively associated with the LSSS score (B=-0.089, SE=0.009, p<0.001) and positively correlated with the serum level of antiepileptic medications (B=3.200, SE=0.416, p<0.001), after adjusting for demographics and clinical characteristics. The serum level of antiepileptic drugs was significantly correlated with the overall QOLIE-31 score (B=3.118, SE=1.417, p=0.03). The MARS-5 score was significantly correlated with the overall QOLIE-31 scores and all the scores in the subcategories. In addition, the MARS-5 score was in line with the correlation between the LSSS and QOLIE-31 scores (Z=4.20, p<0.001) and between serum antiepileptic medication levels and QOLIE-31 score (Z=3.98, p<0.001). CONCLUSIONS The MARS-5 score can predict the QoL in patients with epilepsy for up to 18months. Therefore, healthcare providers may predict the QoL and drug adherence using the MARS-5 score, in order to design personalized interventions.
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Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, NSW 2007, Australia
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahounar BLV, Qazvin 3419759811, Iran.
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PatientsLikeMe® Online Epilepsy Community: Patient characteristics and predictors of poor health-related quality of life. Epilepsy Behav 2016; 63:20-28. [PMID: 27544877 DOI: 10.1016/j.yebeh.2016.07.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/06/2016] [Accepted: 07/24/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The online PatientsLikeMe® Epilepsy Community allows patients with epilepsy to record, monitor, and share their demographic, disease, and treatment characteristics, providing valuable insights into patient perceptions and understanding of epilepsy. The objective of this retrospective analysis was to characterize the profile of users and their disease and identify factors predictive of poor health-related quality of life (HRQoL), while assessing the platform's potential in providing patient-reported data for research purposes. METHODS Data recorded (January 2010-November 2011) by Epilepsy Community members, with an epilepsy diagnosis and who reported >1 seizure, included the following: sociodemographic and disease characteristics, treatments, symptoms, side effects perceived as medication-related, seizure occurrence, and standardized questionnaires (Quality of Life in Epilepsy Inventory [QOLIE-31/P], EuroQoL 5-Dimensions Scale, 3 Levels [EQ-5D-3L], and Hospital Anxiety and Depression Scale [HADS]). Univariate and multivariate logistic regressions were conducted to identify predictors of poor HRQoL. RESULTS During the study period, the Epilepsy Community comprised 3073 patients, of whom 71.5% were female, had a mean age of 37.8years, and had a mean epilepsy duration of 17.7years. The most frequently reported moderate/severe symptoms (n=2135) included memory problems (60.2%), problems concentrating (53.8%), and fatigue (50.0%). Medication-related side effects (n=639) included somnolence (23.2%), fatigue (17.2%), and memory impairment (13.8%). The QOLIE-31/P scores (n=1121) were significantly worse in patients who experienced a recent seizure. For QOLIE-31/P, highly predictive factors for poor HRQoL included the following: mild/moderate problems concentrating, depression, memory problems, treatment side effects, occurrence of tonic-clonic seizures, and epilepsy duration ≤1year. For EQ-5D-3L, highly predictive factors for poor HRQoL included the following: pain, depression, and comorbidities. Patients on newer AEDs were less likely to report poor HRQoL (QOLIE-31/P). SIGNIFICANCE These findings move further towards supporting the feasibility and usefulness of collecting real-world, anonymized data recorded by patients online. The data provide insights into factors impacting HRQoL, suggesting that a holistic treatment approach beyond seizure control should be considered in epilepsy.
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Differences in quality of life of women and men with drug-resistant epilepsy in Poland. Epilepsy Behav 2016; 60:94-98. [PMID: 27195784 DOI: 10.1016/j.yebeh.2016.04.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of the study was to assess the differences in health-related quality of life in groups of men and women suffering with drug-resistant epilepsy and to determine which factors influence quality of life. METHODS The examined group consisted of 64 subjects with drug-resistant epilepsy - 31 men and 33 women. The mean duration of epilepsy was 17.56±8.92 and 19±9.56years, respectively. The following diagnostic tools were used: QOLIE-31-P, Wechsler Adult Intelligence Scale - Revised (WAIS-R (PL)), and Hamilton Rating Scale for Depression (HRSD). RESULTS Scores in QOLIE-31-P did not differ significantly between groups of men and women with drug-resistant epilepsy; however, a more detailed analysis revealed certain disparities. Multiple regression analyses indicated that some distinct factors were associated with quality of life in each sex. In the group of women, there were no significant predictors of their quality of life. Among the group of men, depression intensity was the only statistically significant QoL predictor, explaining 16% of the variance (adjusted R(2)=0.16, F(6, 24)=19.7, p<0.01). Moreover, patients with depression had lowered scores in the Emotional Well-Being and Energy/Fatigue subscales, regardless of the sex. CONCLUSION The study revealed that, despite similar scores in QOLIE-31-P, specific factors may differentially affect the quality of life of men and women with drug-resistant epilepsy in Poland. Nevertheless, replication of these results with a larger number of participants is needed for a more definitive conclusion.
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Toledo M, Whitesides J, Schiemann J, Johnson ME, Eckhardt K, McDonough B, Borghs S, Kwan P. Safety, tolerability, and seizure control during long‐term treatment with adjunctive brivaracetam for partial‐onset seizures. Epilepsia 2016; 57:1139-51. [DOI: 10.1111/epi.13416] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Manuel Toledo
- Vall d'Hebron University Hospital Independent University of Barcelona Barcelona Spain
| | | | | | | | | | | | | | - Patrick Kwan
- University of Melbourne and Royal Melbourne Hospital Parkville Victoria Australia
- Department of Medicine and Therapeutics The Chinese University of Hong Kong Hong Kong China
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Aghaei-Lasboo A, Fisher RS. Methods for Measuring Seizure Frequency and Severity. Neurol Clin 2016; 34:383-94, viii. [DOI: 10.1016/j.ncl.2015.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Borghs S, Tomaszewski EL, Halling K, de la Loge C. Understanding the Patient Perspective of Seizure Severity in Epilepsy: Development of a Conceptual Model. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 9:419-31. [PMID: 27002318 DOI: 10.1007/s40271-016-0165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE For patients with uncontrolled epilepsy, the severity and postictal sequelae of seizures might be more impactful than their frequency. Seizure severity is often assessed using patient-reported outcome (PRO) instruments; however, evidence of content validity for existing instruments is lacking. Our aim was to understand the real-life experiences of patients with uncontrolled epilepsy. METHODS A preliminary conceptual model was developed. The model was refined through (1) a targeted literature review of qualitative research on seizure severity; (2) interviews with four clinical epilepsy experts to evaluate identified concepts; and (3) qualitative interviews with patients with uncontrolled epilepsy, gathering descriptions of symptoms and impacts of epilepsy, focusing on how patients experience and describe "seizure severity." Findings were summarized in a final conceptual model of seizure severity in epilepsy. RESULTS Twenty-five patients (12 who experienced primary generalized tonic-clonic seizures and 13 who experienced partial-onset seizures) expressed 42 different symptoms and 26 different impacts related to seizures. The final conceptual model contained a wide range of concepts related to seizure frequency, symptoms, and duration. CONCLUSION Our model identified several new concepts that characterize the patient experience of seizure severity. A seizure severity PRO instrument should cover a wide range of seizure symptoms alongside frequency and duration of seizures. This qualitative work reinforces the notion that measuring seizure frequency is insufficient and that seizure severity is important in defining the patient's experience of epilepsy. This model could be used to assess the content validity of existing PRO instruments, or could support the development of a new one.
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