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Munger Clary HM, Snively BM, Kumi-Ansu Y, Alexander HB, Kimball J, Duncan P, Conner K, Christopher J, Lohana P, Brenes GA. Quality of life during usual epilepsy care for anxiety or depression symptoms: Secondary patient-reported outcomes in a randomized trial of remote assessment methods. Epilepsy Res 2024; 204:107396. [PMID: 38908323 PMCID: PMC11457121 DOI: 10.1016/j.eplepsyres.2024.107396] [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: 03/29/2024] [Revised: 05/28/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Anxiety and depression are highly prevalent and impactful in epilepsy. American Academy of Neurology quality measures emphasize anxiety and depression screening and quality of life (QOL) measurement, yet usual epilepsy care QOL and anxiety/depression outcomes are poorly characterized. The main objective was to assess 6-month QOL, anxiety and depression during routine care among adults with epilepsy and baseline anxiety or depression symptoms; these were prespecified secondary outcomes within a pragmatic randomized trial of remote assessment methods. METHODS Adults with anxiety or depression symptoms and no suicidal ideation were recruited from a tertiary epilepsy clinic via an electronic health record (EHR)-embedded process. Participants were randomized 1:1 to 6 month outcome collection via patient portal EHR questionnaires vs. telephone interview. This report focuses on an a priori secondary outcomes of the overall trial, focused on patient-reported health outcomes in the full sample. Quality of life, (primary health outcome), anxiety, and depression measures were collected at 3 and 6 months (Quality of Life in Epilepsy-10, QOLIE-10, Generalized Anxiety Disorder-7, Neurological Disorders Depression Inventory-Epilepsy). Change values and 95 % confidence intervals were calculated. In post-hoc exploratory analyses, patient-reported anxiety/depression management plans at baseline clinic visit and healthcare utilization were compared with EHR-documentation, and agreement was calculated using the kappa statistic. RESULTS Overall, 30 participants (15 per group) were recruited and analyzed, of mean age 42.5 years, with 60 % women. Mean 6-month change in QOLIE-10 overall was 2.0(95 % CI -6.8, 10.9), and there were no significant differences in outcomes between the EHR and telephone groups. Mean anxiety and depression scores were stable across follow-up (all 95 % CI included zero). Outcomes were similar regardless of whether an anxiety or depression action plan was documented. During the baseline interview, most participants with clinic visit EHR documentation indicating action to address anxiety and/or depression reported not being offered a treatment(7 of 12 with action plan, 58 %), and there was poor agreement between patient report and EHR documentation (kappa=0.22). Healthcare utilization was high: 40 % had at least one hospitalization or emergency/urgent care visit reported and/or identified via EHR, but a third (4/12) failed to self-report an EHR-identified hospitalization/urgent visit. DISCUSSION Over 6 months of usual care among adults with epilepsy and anxiety or depression symptoms, there was no significant average improvement in quality of life or anxiety/depression, suggesting a need for interventions to enhance routine neurology care and achieve quality of life improvement for this group.
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Affiliation(s)
- Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Beverly M Snively
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Yaw Kumi-Ansu
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Halley B Alexander
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - James Kimball
- Department of Psychiatry, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Pamela Duncan
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kelly Conner
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Physician Assistant Studies, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jerryl Christopher
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Paneeni Lohana
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gretchen A Brenes
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Ogawa M, Fujikawa M, Jin K, Kakisaka Y, Ueno T, Nakasato N. Acceptance of disability predicts quality of life in patients with epilepsy. Epilepsy Behav 2021; 120:107979. [PMID: 33962248 DOI: 10.1016/j.yebeh.2021.107979] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acceptance of disability (AOD) is a key concept in rehabilitation psychology that enhances psychosocial adjustment of individuals with disability. However, the impact of AOD on well-being has never been examined for patients with epilepsy. The present study investigated whether AOD affects quality of life (QOL) in patients with epilepsy in the presence of other multiple aspects of epilepsy based on the biopsychosocial model. METHODS We retrospectively reviewed 151 consecutive patients with epilepsy (77 men, aged 18-74 years) who underwent comprehensive assessment including long-term video-EEG monitoring, neuroimaging studies, and neuropsychological and psychosocial assessment in our epilepsy monitoring unit. Data were obtained from medical records and self-reported questionnaires. The outcome variable was QOL. Predictive variables included demographic characteristics, seizure-related variables (i.e., duration of epilepsy, seizure frequency, and number of antiepileptic drugs), psychological factors (i.e., AOD, depression, and self-stigma), and social factors (i.e., social support and education level). Acceptance of disability was measured by the Adaptation of Disability Scale-Revised (ADS-R), which we translated into Japanese with the original author's approval, and examined its internal consistency reliability. Data were analyzed using four hierarchical multiple regression analysis models. RESULTS The mean ADS-R score was 80 (range 45-115). The predictors accounted for 42% of the variance in QOL (R2 = 0.45, ΔR2 = 0.42, F[8, 141] = 14.47, p = 0.00). Higher AOD (p < 0.01), higher social support (p < 0.01), and lower depression scores (p = 0.02) were found to contribute significantly to higher overall QOL. CONCLUSION The present study revealed AOD as an important psychological concept, in addition to social support and depression as previously reported, to improve the QOL of patients with epilepsy. Acceptance of disability should be incorporated in the intervention to increase QOL of patients with epilepsy.
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Affiliation(s)
- Maimi Ogawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mayu Fujikawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Ueno
- Faculty of Comprehensive Welfare, Tohoku Fukushi University, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Tsigebrhan R, Fekadu A, Medhin G, Newton CR, Prince MJ, Hanlon C. Comorbid mental disorders and quality of life of people with epilepsy attending primary health care clinics in rural Ethiopia. PLoS One 2021; 16:e0238137. [PMID: 33471799 PMCID: PMC7817054 DOI: 10.1371/journal.pone.0238137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/10/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Evidence from high-income countries demonstrates that co-morbid mental disorders in people with epilepsy adversely affect clinical and social outcomes. However, evidence from low-income countries is lacking. The objective of this study was to measure the association between co-morbid mental disorders and quality of life and functioning in people with epilepsy. METHODS A facility-based, community ascertained cross-sectional survey was carried out in selected districts of the Gurage Zone, Southern Ethiopia. Participants were identified in the community and referred to primary health care (PHC) clinics. Those diagnosed by PHC workers were recruited. Co-morbid mental disorders were measured using a standardised, semi-structured clinical interview administered by mental health professionals. The main outcome, quality of life, was measured using the Quality of Life in Epilepsy questionnaire (QOLIE-10p). The secondary outcome, functional disability, was assessed using the 12-item World Health Organization Disability Assessment Schedule (WHODAS-2). RESULTS The prevalence of comorbid mental disorders was 13.9%. Comorbid mental disorders were associated with poorer quality of life (Adjusted (Adj.) β -13.27; 95% CI -23.28 to-3.26) and greater disability (multiplier of WHODAS-2 score 1.62; 95% CI 1.05, 2.50) after adjusting for hypothesised confounding factors. Low or very low relative wealth (Adj. β = -12.57, 95% CI -19.94 to-5.20), higher seizure frequency (Adj.β coef. = -1.92, 95% CI -2.83 to -1.02), and poor to intermediate social support (Adj. β coef. = -9.66, 95% CI -16.51 to -2.81) were associated independently with decreased quality of life. Higher seizure frequency (multiplier of WHODAS-2 score 1.11; 95% CI 1.04, 1.19) was associated independently with functional disability. CONCLUSION Co-morbid mental disorders were associated with poorer quality of life and impairment, independent of level of seizure control. Integrated and comprehensive psychosocial care is required for better health and social outcomes of people with epilepsy.
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Affiliation(s)
- Ruth Tsigebrhan
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Girmay Medhin
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles R. Newton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, United Kingdom
| | - Martin J. Prince
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Kim JS, Kim DY, Jo HJ, Hwang YH, Song JY, Yang KI, Hong SB. Effect of Long-Term Treatment with Vagus Nerve Stimulation on Mood and Quality of Life in Korean Patients with Drug-Resistant Epilepsy. J Clin Neurol 2021; 17:385-392. [PMID: 34184446 PMCID: PMC8242313 DOI: 10.3988/jcn.2021.17.3.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the long-term effects of vagus nerve stimulation (VNS) treatment on suicidality, mood-related symptoms, and quality of life (QOL) in patients with drug-resistant epilepsy (DRE). We also investigated the relationships among these main effects, clinical characteristics, and VNS parameters. METHODS Among 35 epilepsy patients who underwent VNS implantation consecutively in our epilepsy center, 25 patients were recruited to this study for assessing the effects of VNS on suicidality, mood-related symptoms, and QOL. The differences in these variables between before and after VNS treatment were analyzed statistically using paired t-tests. Multiple linear regression analyses were also performed to determine how the patients' demographic and clinical characteristics influenced the variables that showed statistically significant changes after long-term VNS treatment. RESULTS After VNS, our patients showed significant improvements not only in the mean seizure frequency but also in suicidality, depression, and QOL. The reduction in depression was associated with the improvement in QOL and more-severe depression at baseline. The reduction in suicidality was associated with higher suicidality at baseline, smaller changes in depression, and less-severe depression at baseline. Improved QOL was associated with lower suicidality at baseline. CONCLUSIONS This study found that VNS decreased the mean seizure frequency in patients with DRE, and also improved their depression, suicidality, and QOL. These results provide further evidence for therapeutic effect of VNS on psychological comorbidities of patients with DRE.
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Affiliation(s)
- Jeong Sik Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Yeop Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jin Jo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Ha Hwang
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Yeon Song
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Seung Bong Hong
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea.
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Tedrus GMAS, Crepaldi CR, de Almeida Fischer B. Quality of life perception in patients with epilepsy for a period of 4 years. Epilepsy Behav 2020; 111:107318. [PMID: 32693383 DOI: 10.1016/j.yebeh.2020.107318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/07/2023]
Abstract
UNLABELLED The quality of life (QoL) perception over time in adult people with epilepsy (PWE) is important to define strategies of conduct. OBJECTIVE The aim of this study was to assess the minimally important change (MIC) threshold of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) of PWE over a period of 4 years and its relationship with clinical epilepsy variables. METHODS A total of 129 PWE (46 ± 14.3 years) were included, and the clinical aspects of epilepsy and the QOLIE-31 were assessed in the initial and final assessment, with p < 0.05. RESULTS The emotional well-being (-6.31) and social functioning (-5.36) showed clinically relevant effects between the assessments. Quality of life was compromised by increasing the number of antiepileptic drugs (AED) taken [total score (-8.53), social functioning (-14.70)] or by maintaining the use of polytherapy [social functioning (-12.89)]. Fewer seizures were associated with a better QoL [total score (7.99), social (17.88) and cognitive functioning (16.30)]. The reduction in seizures was not associated with a better QoL [total and social functioning score], and the increase in seizures did not change QoL perception (cognitive functioning). There was a reduction in the QoL perception in medication effects in temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) (8.92) and with an increase in age in one year (-0.44). CONCLUSIONS Quality of life was compromised in the emotional well-being and social functioning during the 4-year follow-up period. The increase in the number of AED taken and age and the TLE-HS compromised QoL changes in the frequency of seizures not associated with a significant improvement in QoL.
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Affiliation(s)
- Glória Maria A S Tedrus
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
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Winslow J, Hu B, Tesar G, Jehi L. Longitudinal trajectory of quality of life and psychological outcomes following epilepsy surgery. Epilepsy Behav 2020; 111:107283. [PMID: 32759066 PMCID: PMC8892470 DOI: 10.1016/j.yebeh.2020.107283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study investigated self-reported longitudinal quality of life (QOL) and symptoms of depression and anxiety in patients who had resective surgery. The study characterized the extent, sustainability, and longitudinal trajectory of psychosocial postsurgical outcomes. METHODS This retrospective study included adults who underwent resective epilepsy surgery in Cleveland Clinic Epilepsy Center between 2008 and 2013. Clinic visits were between October 2007 and December 2014. Data studied were from visits prior to surgery, early postsurgery follow-up (mean: 0.9 years; range: 0.5 to 3.4), and most recent follow-up (mean: 3.2 years; range: 0.8 to 6.9). Patient demographics, clinical features, and surgical factors were collected. Analysis focused on self-reported quality of life (QOLIE-10), depression (PHQ-9), and anxiety (GAD-7). RESULTS The study included 229 adults, of whom 178 had complete follow-up with data from all three time points. Following surgery, scores on Quality of life in epilepsy inventory (QOLIE-10), Patient health questionnaire (PHQ-9), and General anxiety disorder (GAD-7) improved significantly with time. After adjusting for gender, age, marital status, and type of surgery using linear modeling, the mean QOLIE-10 score decreased by 1.157 points/year, mean PHQ-9 score by 0.331 points/year, and mean GAD-7 score by 0.299 points/year. Improvement in QOL continued to be observed throughout the follow-up duration, whereas both depression and anxiety improved the most within the first postoperative year and then stabilized. Seizure freedom was strongly correlated with improved QOL (p = 0.001), while depressive symptoms showed a nonstatistically significant correlation with worse QOL (p = 0.07). Patients who underwent frontal resection had significantly superior QOL and depression symptom improvement compared with temporal resections during full data analysis (QOLIE-10, p = 0.024; PHQ-9, p = 0.027), but only significant depression symptom improvement on secondary analysis of complete follow-up patients only (PHQ, p = 0.040; QOL, p = 0.104). SIGNIFICANCE This study provides a longitudinal perspective of QOL and psychological symptoms in patients with postresective epilepsy with a cohort with 38% extratemporal cases. Results illustrate positive trajectory of psychosocial outcomes postsurgery with early QOL and mood improvement, and years of further QOL gains. Frontal lobe surgery patients may have superior improvement in some psychosocial measures compared with temporal lobe surgery patients.
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Affiliation(s)
- Jessica Winslow
- Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Bo Hu
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - George Tesar
- Psychiatry and Psychology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Willems LM, Kondziela JM, Knake S, Schulz J, Neif B, Schade B, Gerlinger S, Neubauer BA, Brunst B, Schubert-Bast S, Fuchs S, Staab-Kupke H, Kniess T, Rosenow F, Strzelczyk A. Counseling and social work for people with epilepsy in Germany: A cross-sectional multicenter study on demand, frequent content, patient satisfaction, and burden-of-disease. Epilepsy Behav 2019; 92:114-120. [PMID: 30654230 DOI: 10.1016/j.yebeh.2018.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The diagnosis of epilepsy is accompanied by relevant personal, interpersonal, and professional restrictions for patients and their caregivers. Specialized epilepsy counseling services (ECS) have been introduced to inform, advise, and support patients with disease-related problems. AIM AND SCOPE The objective of this cross-sectional, multicenter study was to determine the demand, typical content, and outcomes of ECS in children, adolescents, and adults in two adjacent German regions of Hessen and Lower Franconia. All ECS sites in these regions participated in 2014 and 2015, offering a total population of 7.5 million inhabitants. RESULTS A total number of 435 patients [323 adults (74.3%), 51.7% female, mean age: 40.3 ± 14.7 years and 112 children/adolescents (25.7%), 52.7% female, mean age: 9.4 ± 4.6 years] were enrolled at six ECS sites. The most common reasons for counseling were general information needs (n = 304; 69.9%), administrative help (n = 208; 47.8%), problems with education or work (n = 176; 40.5%), and recreational activities (n = 119; 27.3%). In addition, 6.2% reported epilepsy-related questions on family planning as a specific reason for desiring counseling. Recommendation by the treating physicians was the most frequent reason for receiving counseling through ECS (62.5%), and most patients preferred to receive a personal consultation (73.1%). Patient satisfaction as measured by the ZUF-8 client satisfaction score was high with a mean of 29.7 points (standard deviation: ±2.7 points, median: 29.9 points), and 83.9% of patients said they would recommend ECS. Disease-related job loss or change in school was avoided in 72% of 82 patients. Suggestions for improvement of ECS included an extension of service hours (58.6%) and a better availability of more sites located nearby (32.8%). CONCLUSION Epilepsy counseling services are necessary, valued, and effective institutions for people with epilepsy complementing outpatient and inpatient care. To improve the care for people with epilepsy, access to and availability of ECS should be improved.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Jacqueline M Kondziela
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Juliane Schulz
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Birgit Neif
- Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
| | - Bernd Schade
- Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
| | - Stefan Gerlinger
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernd A Neubauer
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernhard Brunst
- Epilepsy Counseling Diakonisches Werk Hochtaunus, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Simone Fuchs
- Epilepsy Counseling Unterfranken, Stiftung Juliusspital, Würzburg, Germany
| | | | - Tobias Kniess
- Department of Neurology, Campus Rhön Klinikum AG, Bad Neustadt a.d. Saale, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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Steriade C, Martins W, Bulacio J, Morita-Sherman ME, Nair D, Gupta A, Bingaman W, Gonzalez-Martinez J, Najm I, Jehi L. Localization yield and seizure outcome in patients undergoing bilateral SEEG exploration. Epilepsia 2018; 60:107-120. [PMID: 30588603 DOI: 10.1111/epi.14624] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aimed to determine the rates and predictors of resection and seizure freedom after bilateral stereo-electroencephalography (SEEG) implantation. METHODS We reviewed 184 patients who underwent bilateral SEEG implantation (2009-2015). Noninvasive and invasive evaluation findings were collected. Outcomes of interest included subsequent resection and seizure freedom. Statistical analyses employed multivariable logistic regression and proportional hazard modeling. Preoperative and postoperative seizure frequency, severity, and quality of life scales were also compared. RESULTS Following bilateral SEEG implantation, 106 of 184 patients (58%) underwent resection. Single seizure type (P = 0.007), a family history of epilepsy (P = 0.003), 10 or more seizures per month (P = 0.004), lower number of electrodes (P = 0.02), or sentinel electrode placement (P = 0.04) was predictive of undergoing a resection, as were lack of nonlocalized (P < 0.0001) or bilateral (P < 0.0001) ictal-onset zones on SEEG. Twenty-six of 81 patients (32% with follow-up greater than 1 year) remained seizure-free. Predictors of seizure freedom were single seizure type (P = 0.01), short epilepsy duration (P = 0.008), use of 2 or fewer antiepileptic drugs (AEDs) at the time of surgery (P = 0.0006), primary localization hypothesis involving the frontal lobe (P = 0.002), sentinel electrode placement only (P = 0.02), and lack of overlap between ictal-onset zone and eloquent cortex (P = 0.04), along with epilepsy substrate histopathology (P = 0.007). Complete resection of a suspected focal cortical dysplasia showed a trend to increased likelihood of seizure freedom (P = 0.09). The 44 of 55 patients (80%) who underwent resection and experienced seizure recurrence had >50% seizure reduction, as opposed to 26 of 45 patients (58%) who continued medical therapy alone (P = 0.003). Seventy-two percent of patients had a clinically meaningful quality of life improvement (>10% decrease in the Quality of Life in Epilepsy [QOLIE-10] score) at 1 year. SIGNIFICANCE A strong preimplantation hypothesis of a suspected unifocal epilepsy increases the odds of resection and seizure freedom. We discuss a tailored approach, taking into account localization hypothesis and suspected epilepsy etiology in guiding implantation and subsequent surgical strategy.
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Affiliation(s)
- Claude Steriade
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - William Martins
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio.,Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas, Porto Alegre, Brazil
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajay Gupta
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
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Friedman D, Spruill TM, Liu H, Tatsuoka C, Stoll S, Jobst BC, Fraser RT, Johnson EK, Chaytor N, Sajatovic M. Depressive symptoms and suicidality among individuals with epilepsy enrolled in self-management studies: Results from the US Centers for Disease Control and Prevention Managing Epilepsy Well (MEW) Network. Epilepsy Behav 2018; 87:235-240. [PMID: 30115600 DOI: 10.1016/j.yebeh.2018.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 11/20/2022]
Abstract
Depression is a common comorbidity in people with epilepsy (PWE) that negatively affects self-management and a variety of health outcomes. Suicidal ideation is also more common among PWE than the general population. We examined correlates of depressive symptoms and suicidal ideation in adults using pooled data from epilepsy self-management studies conducted by sites in the Centers for Disease Control and Prevention (CDC) Research Center's Managing Epilepsy Well (MEW) Network that assessed depression severity with the 9-item Patient Health Questionnaire (PHQ-9). Of the 770 subjects in the analysis (mean age 42.4 ± 13.0 years), the mean total PHQ-9 score was 9.4 ± 6.6 and 334 subjects (43.4%) had moderate to severe depressive symptoms (PHQ-9 ≥ 10). Only ongoing seizures and low education were associated with moderate-severe depressive symptoms in multiple logistic regression analysis. Suicidality (PHQ-9, item 9 score ≥ 1) was endorsed by 155 subjects (20.1%). Only nonsuicidal depressive symptoms were associated with suicidality in multiple variable logistic regression analysis. We show in this large and regionally diverse dataset that both depression and suicidal ideation are common among PWE enrolled in self-management studies. Future studies are needed to examine whether suicidality exists independently of other depressive symptoms in some populations with epilepsy and investigate other correlates of suicidality that may inform screening practices.
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Affiliation(s)
- Daniel Friedman
- Department of Neurology, NYU School of Medicine, New York, NY, United States.
| | - Tanya M Spruill
- Department of Population Health, NYU School of Medicine, New York, NY, United States
| | - Hongyan Liu
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Shelley Stoll
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, United States
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Robert T Fraser
- School of Public Health, Univ. of Washington, Seattle, WA, United States
| | - Erica K Johnson
- School of Public Health, Univ. of Washington, Seattle, WA, United States
| | - Naomi Chaytor
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Martha Sajatovic
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Departments of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
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10
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Willems LM, Watermann N, Richter S, Kay L, Hermsen AM, Knake S, Rosenow F, Strzelczyk A. Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study. Front Neurol 2018; 9:414. [PMID: 29963000 PMCID: PMC6013746 DOI: 10.3389/fneur.2018.00414] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/18/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: This study was designed to evaluate risk factors and incidence of epilepsy-related injuries and accidents (ERIA) at an outpatient clinic of a German epilepsy center providing healthcare to a mixed urban and rural population of over one million inhabitants. Methods: Data acquisition was performed between 10/2013 and 09/2014 using a validated patient questionnaire on socioeconomic status, course of epilepsy, quality of life (QoL), depression, injuries and accidents associated with seizures or inadequate periictal patterns of behavior concerning a period of 3 months. Univariate analysis, multiple testing and regression analysis were performed to identify possible variables associated with ERIA. Results: A total of 292 patients (mean age 40.8 years, range 18-86; 55% female) were enrolled and analyzed. Focal epilepsy was diagnosed in 75% of the patients. The majority was on an antiepileptic drug (AEDs) polytherapy (mean number of AEDs: 1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related injuries and accidents in a 3-month period. Besides lacerations (n = 18, 6.2%), abrasions and bruises (n = 9, 3.1%), fractures (n = 6, 2.2%) and burns (n = 3, 1.0%), 17 mild injuries (5.8%) were reported. In 20 (6.8% of the total cohort) cases, urgent medical treatment with hospitalization was necessary. Epilepsy-related injuries and accidents were related to active epilepsy, occurrence of generalized tonic-clonic seizures (GTCS) and drug-refractory course as well as reported ictal falls, ictal loss of consciousness and abnormal peri-ictal behavior in the medical history. In addition, patients with ERIA had significantly higher depression rates and lower QoL. Conclusion: ERIA and their consequences should be given more attention and standardized assessment for ERIA should be performed in every outpatient visit.
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Affiliation(s)
- Laurent M Willems
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Nina Watermann
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Saskia Richter
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Lara Kay
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Anke M Hermsen
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Knake
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
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11
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Willems LM, Richter S, Watermann N, Bauer S, Klein KM, Reese JP, Schöffski O, Hamer HM, Knake S, Rosenow F, Strzelczyk A. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany from 2003 to 2013 - A ten-year overview. Epilepsy Behav 2018; 83:28-35. [PMID: 29649671 DOI: 10.1016/j.yebeh.2018.03.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Abstract
This study evaluated trends in resource use and prescription patterns in patients with active epilepsy over a 10-year period at the same outpatient clinic of a German epilepsy center. We analyzed a cross-sectional patient sample of consecutive adults with active epilepsy over a 3-month period in 2013 and compared them with equally acquired data from the years 2003 and 2008. Using validated patient questionnaires, data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded. A total of 198 patients (mean age: 39.6±15.0years, 49.5% male) were enrolled and compared with our previous assessments in 2003 (n=101) and 2008 (n=151). In the 2013 cohort, 75.8% of the patients had focal epilepsy, and the majority were taking antiepileptic drugs (AEDs) (39.9% monotherapy, 59.1% polytherapy). We calculated epilepsy-specific costs of €3674 per three months per patient. Direct medical costs were mainly due to anticonvulsants (20.9% of total direct costs) and to hospitalization (20.8% of total direct costs). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2013. Indirect costs of €1795 in 2013 were mainly due to early retirement (55.0% of total indirect costs), unemployment (26.5%), and days off due to seizures (18.2%). In contrast to our previous findings from 2003 and 2008, our data show a stagnating cost increase with slightly reduced total costs and balanced direct and indirect costs in patients with active epilepsy. These findings are accompanied by an ongoing cost-neutral increase in the prescription of 'newer' and non-enzyme-inducing AEDs. However, the number and distribution of indirect cost components remained unchanged.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Saskia Richter
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Nina Watermann
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Jens-Peter Reese
- Coordinating Center for Clinical Trials, Philipps-University, Marburg, Germany
| | - Oliver Schöffski
- Department of Health Management, Friedrich-Alexander-University, Nuremberg, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, Friedrich-Alexander-University, Erlangen, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany.
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12
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Vallée C, Biraben A, Nica A, Loiseau M. [Epidemiology and associated factors with depression among people suffering from epilepsy: A transversal French study in a tertiary center]. Encephale 2018. [PMID: 29525447 DOI: 10.1016/j.encep.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The occurrence of depression in people with epilepsy is almost twice as common as in the general population. Furthermore, depression is the first cause of lower quality of life among those patients. Which is why the main goal of this study was to assess the epidemiology of depression and its associated factors among the patients from the tertiary department of epileptology in Rennes. METHODS/RESULTS The subjects were included prospectively and consecutively at the moment of their consultation or hospitalisation in the department. Personal data about the socio-economic status and the type of epilepsy was collected. The subjects filled validated self-assessment of depression (NDDIE), anxiety (GAD-7) and quality of life (QOLIE-10). Thanks to the NDDIE, the patients were divided into: "depressed" and "not depressed"; and the two groups were compared with univariate and multivariate models. Of the 322 patients followed-up in the department between the 17th of June and the 9th of September 2016 223 of them were included in the study. According to the NDDIE, 22.6% suffered from depression; according to the GAD-7, 46.4% suffered from anxiety. In the "depressed" group, 82% were not under anti-depressant medication. In the univariate model, depression was associated with: anxiety, suicidal ideations, lower quality of life, vague nervus stimulation treatment, anticonvulsant benzodiazepine medication or psychiatric medication, and last of all bitherapy or polytherapy antiepileptic medication compared to monotherapy. In the multivariate model, depression was significantly related to anxiety (OR: 8.86 [3.00; 26.19] p=0.0001), suicidal ideas (OR: 7.43 [2.93; 18.81] p<0.0001), anticonvulsant benzodiazepine medication (OR: 3.31 [1.16; 9.49] p=0.0255), and lower quality of life (OR: 1.09 [1.02; 1.17] p=0.0087). Generalised epilepsy was a protective factor with uni and multivariate models (OR: 0.34 [0.11; 1.00] p=0.0492). CONCLUSIONS In the tertiary epileptic department of Rennes, more than 20% of patients with epilepsy suffered from depression during the inclusion period according to the NDDIE. Among those "depressed" subjects, fewer than one out of five seemed to receive proper psychiatric care. Which is why this study highlights the importance of interdisciplinary cooperation between neurologists and psychiatrists in order to aim at better management of epileptic patients as a whole.
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Affiliation(s)
- C Vallée
- DES de neurologie, CHU de Rennes, 35000 Rennes, France.
| | - A Biraben
- Département d'épileptologie, CHU de Rennes, 35000 Rennes, France.
| | - A Nica
- Département d'épileptologie, CHU de Rennes, 35000 Rennes, France
| | - M Loiseau
- DES de psychiatrie, CHU de Dijon, 21000 Dijon, France.
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13
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Xu Y, Hackett ML, Glozier N, Nikpour A, Somerville E, Bleasel A, Ireland C, Anderson CS. Return to driving after a diagnosis of epilepsy: A prospective registry study. Epilepsia 2018; 59:661-667. [DOI: 10.1111/epi.14001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ying Xu
- The George Institute for Global Health Faculty of Medicine University of New South Wales Camperdown New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Maree L. Hackett
- The George Institute for Global Health Faculty of Medicine University of New South Wales Camperdown New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
- Faculty of Health and Wellbeing University of Central Lancashire Preston UK
| | - Nick Glozier
- Brain and Mind Centre University of Sydney Camperdown New South Wales Australia
| | - Armin Nikpour
- Neurology Department Sydney Local Area Health District Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - Ernest Somerville
- Neurology Department Prince of Wales Clinical School University of New South Wales Randwick New South Wales Australia
| | - Andrew Bleasel
- Neurology Department Westmead Hospital Westmead New South Wales Australia
| | - Carol Ireland
- Epilepsy Action Australia Epping New South Wales Australia
| | - Craig S. Anderson
- The George Institute for Global Health Faculty of Medicine University of New South Wales Camperdown New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
- Neurology Department Sydney Local Area Health District Royal Prince Alfred Hospital Camperdown New South Wales Australia
- The George Institute for Global Health Peking University Health Science Center Beijing China
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14
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Strzelczyk A, Griebel C, Lux W, Rosenow F, Reese JP. The Burden of Severely Drug-Refractory Epilepsy: A Comparative Longitudinal Evaluation of Mortality, Morbidity, Resource Use, and Cost Using German Health Insurance Data. Front Neurol 2017; 8:712. [PMID: 29312132 PMCID: PMC5743903 DOI: 10.3389/fneur.2017.00712] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/11/2017] [Indexed: 01/14/2023] Open
Abstract
Purpose To evaluate long-term outcome of three years and treatment patterns of patients suffering from severely drug-refractory epilepsy (SDRE). Methods This analysis was population-based and retrospective, with data collected from four million individuals insured by statutory German health insurance. ICD-10 codes for epilepsy (G40*) and intake of anticonvulsants were used to identify prevalent cases, which were then compared with a matched cohort drawn from the population at large. Insurance data were available from 2008 to 2013. Any patient who had been prescribed with at least four different antiepileptic drugs (AEDs) in an 18-month period was defined as an SDRE case. Results A total of 769 patients with SDRE were identified. Of these, 19% were children and adolescents; the overall mean age was 42.3 years, 45.4% were female and 54.6% male. An average of 2.7 AEDs per patient was prescribed during the first follow-up year. The AEDs most commonly prescribed were: levetiracetam (53.5%), lamotrigine (41.4%), valproate (41.3%), lacosamide (20.4%), and topiramate (17.8%). During 3-year follow-up, there was an annual rate of hospitalization in the range 42.7 to 55%, which was significantly higher than the 11.6–12.8% (p < 0.001) for the matched controls. Admissions to hospital because of epilepsy ranged between 1.7 and 1.9 per year, with an average duration for each epilepsy-caused hospitalization of 10–11.1 days. The number of comorbidities for SDRE patients was significantly increased compared with the matched controls: depression (28% against 10%), vascular disorders (22% against 5%), and injury rates were also higher (head 16% against 3%, trunk and limbs 16% against 8%). The 3-year mortality rate for SDRE patients was 14% against 2.1% in the matched cohort. Conclusion SDRE patients are treated with AED polytherapy for all of the 3-year follow-up period. They are hospitalized more frequently than the general population and show increased morbidity levels and a sevenfold increase in mortality rate over 3 years. Further examination is required of ways in which new approaches to treatment could lead to better outcomes in severely affected patients.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | | | - Wolfram Lux
- HGC GesundheitsConsult GmbH, Düsseldorf, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Jens-Peter Reese
- Institute of Health Service Research and Clinical Epidemiology, Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg, Germany
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15
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16
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Kováts D, Császár N, Haller J, Juhos V, Sallay V, Békés J, Kelemen A, Fabó D, Rásonyi G, Folyovich A, Kurimay T. Factors affecting quality of life in Hungarian adults with epilepsy: A comparison of four psychiatric instruments. Epilepsy Behav 2017; 74:45-58. [PMID: 28686907 DOI: 10.1016/j.yebeh.2017.04.035] [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: 02/10/2017] [Revised: 03/30/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We investigated the impact of 19 factors on life quality in Hungarian patients with epilepsy. Wellbeing was evaluated by several inventories to investigate the impact of factors in more detail. METHODS A cross-sectional study was performed in 170 patients. Wellbeing was evaluated with the WHO-5 Well-being Index (WHOQOL-5), Diener Satisfaction with Life Scale (SwLS), and the Quality of Life in Epilepsy-31 Questionnaire (Qolie-31). We investigated their association with demographic characteristics, general health status, epilepsy, and its treatment. The impact of these factors on illness perception (Illness Perception Questionnaire, IPQ) was also studied. RESULTS The four measures correlated highly significantly. In addition, the predictive power of factors was comparable with the four inventories as evaluated by Multiple Regression. Factors explained 52%, 41%, 63% and 46% in the variance of WHOQOL-5, SwLS, Qolie-31, and IPQ scores, respectively. However, associations with particular factors were instrument-specific. The WHOQOL-5 was associated with factors indicative of general health. SwLS scores were associated with health-related and several demographic factors. Neither showed associations with epilepsy-related factors. All four categories of factors were associated with Qolie-31 and IPQ scores. Factors had an additive impact on IPQ, but not on Qolie-31. SIGNIFICANCE Our findings reveal interactions between the method of life quality assessment and the factors that are identified as influencing life quality. This appears to be the first study that analyses the factors that influence illness perception in epilepsy patients, and suggests that the IPQ may become a valuable tool in epilepsy research.
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Affiliation(s)
| | - Noémi Császár
- Károli Gáspár University, Faculty of Humanities, Institute of Psychology, Budapest, Hungary
| | - József Haller
- National University of Public Service, Budapest, Hungary; Institute of Experimental Medicine, Budapest, Hungary
| | - Vera Juhos
- Pediatric and Adult Epilepsy-Neurology Centre, Budapest, Hungary
| | - Viola Sallay
- University of Szeged, Department of Clinical and Health Psychology, Institute of Psychology, Szeged, Hungary
| | - Judit Békés
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - György Rásonyi
- National Institute of Clinical Neurosciences, Budapest, Hungary; Neurocenter, Rigshospitalet, Copenhagen University, Denmark
| | - András Folyovich
- Szent János Hospital of the Municipality of Budapest, United Hospitals of North Buda, Department of Neurology, Budapest, Hungary
| | - Tamás Kurimay
- Szent János Hospital of the Municipality of Budapest, United Hospitals of North Buda, Department of Psychiatry and Psychiatric Rehabilitation, Budapest, Hungary
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Long-Term Seizure, Quality of Life, Depression, and Verbal Memory Outcomes in a Controlled Mesial Temporal Lobe Epilepsy Surgical Series Using Portuguese-Validated Instruments. World Neurosurg 2017; 104:411-417. [DOI: 10.1016/j.wneu.2017.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 11/24/2022]
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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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Strzelczyk A, Bergmann A, Biermann V, Braune S, Dieterle L, Forth B, Kortland LM, Lang M, Peckmann T, Schöffski O, Sigel KO, Rosenow F. Neurologist adherence to clinical practice guidelines and costs in patients with newly diagnosed and chronic epilepsy in Germany. Epilepsy Behav 2016; 64:75-82. [PMID: 27732920 DOI: 10.1016/j.yebeh.2016.07.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/08/2016] [Accepted: 07/25/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to evaluate physician adherence to the German Neurological Society guidelines of 2008 regarding initial monotherapy and to determine the cost-of-illness in epilepsy. METHODS This was an observational cohort study using health data routinely collected at 55 outpatient neurology practices throughout Germany (NeuroTransData network). Data on socioeconomic status, course of epilepsy, anticonvulsive treatment, and direct and indirect costs were recorded using practice software-based questionnaires. RESULTS One thousand five hundred eighty-four patients with epilepsy (785 male (49.6%); mean age: 51.3±18.1years) were enrolled, of whom 507 were newly diagnosed. Initial monotherapy was started according to authorization status in 85.9%, with nonenzyme-inducing drugs in 94.3% of all AEDs. Drugs of first choice by guideline recommendations were used in 66.5%. Total annual direct costs in the first year amounted to €2194 (SD: €4273; range: €55-43,896) per patient, with hospitalization (59% of total direct costs) and anticonvulsants (30%) as the main cost factors. Annual total direct costs decreased by 29% to €1572 in the second year, mainly because of a 59% decrease in hospitalization costs. The use of first choice AEDs did not influence costs. Chronic epilepsy was present in 1077 patients, and total annual direct costs amounted to €1847 per patient, with anticonvulsants (51.0%) and hospitalization (41.0%) as the main cost factors. Potential cost-driving factors in these patients were active epilepsy and focal epilepsy syndrome. CONCLUSION This study shows excellent physician adherence to guidelines regarding initial monotherapy in adults with epilepsy. Newly diagnosed patients show higher total direct and hospital costs in the first year upon diagnosis, but these are not influenced by adherence to treatment guidelines.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany.
| | | | - Valeria Biermann
- Department of Health Management, Friedrich-Alexander-University (FAU), Erlangen-Nuremberg, Germany
| | | | | | | | - Lena-Marie Kortland
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Michael Lang
- NeuroTransData, NTD Study Group, Neuburg, Germany
| | | | - Oliver Schöffski
- Department of Health Management, Friedrich-Alexander-University (FAU), Erlangen-Nuremberg, Germany
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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20
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Ertl J, Hapfelmeier J, Peckmann T, Forth B, Strzelczyk A. Guideline conform initial monotherapy increases in patients with focal epilepsy: A population-based study on German health insurance data. Seizure 2016; 41:9-15. [DOI: 10.1016/j.seizure.2016.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022] Open
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21
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Chen HF, Tsai YF, Hsi MS, Chen JC. Factors affecting quality of life in adults with epilepsy in Taiwan: A cross-sectional, correlational study. Epilepsy Behav 2016; 58:26-32. [PMID: 27002941 DOI: 10.1016/j.yebeh.2016.02.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to assess eight factors considered important for quality of life in persons with epilepsy in order to determine which of these components affect quality of life in adults with epilepsy in Taiwan. METHODS A cross-sectional, correlational study using structured questionnaires assessed 260 patients with epilepsy purposively sampled from a medical center in Northern Taiwan. Health-related quality of life (HRQoL) was evaluated with the Quality of Life in Epilepsy-31 (QOLIE-31) questionnaire. Data also included personal and health-related characteristics, knowledge of epilepsy, efficacy in the self-management of epilepsy, and social support. RESULTS Scores for the QOLIE-31 were correlated with the following factors: (1) demographic characteristics of age, gender, and income; (2) sleep quality; (3) symptoms of anxiety and depression; (4) epilepsy-specific variables: seizure frequency; types, number, and frequency of antiepileptic drugs (AEDs); and adverse events of AEDs; and (5) social support. Stepwise regression analysis showed that seven factors were predictive for quality of life: anxiety, depression, adverse events of AEDs, social support, seizure frequency of at least once in three months, household income of NT$ 40,001-100,000, and male gender. These factors accounted for 58.2% of the variance of quality of life. SIGNIFICANCE Our study assessed multiple factors in an examination of relationships and predictive factors for quality of life in adults with epilepsy in Taiwan. Knowledge of these contributing factors can assist health-care providers when evaluating patients with epilepsy to help target interventions for improving quality of life.
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Affiliation(s)
- Hsiu-Fang Chen
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | - Mo-Song Hsi
- Department of Neurology, Chang Gung Memorial Hospital at Taipei, Taiwan; Taiwan Epilepsy Association, Taiwan
| | - Jui-Chen Chen
- Department of Nursing, Chang Gung Memorial Hospital at Taipei, Taiwan; Taiwan Epilepsy Association, Taiwan
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Mutluay FK, Gunduz A, Tekeoglu A, Oguz S, Yeni SN. Health related quality of life in patients with epilepsy in Turkey. J Phys Ther Sci 2016; 28:240-5. [PMID: 26957766 PMCID: PMC4756012 DOI: 10.1589/jpts.28.240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/16/2015] [Indexed: 01/22/2023] Open
Abstract
[Purpose] This study measured the quality of life in epilepsy and determined
associated demographic and clinical factors by means of the Short Form-36 health survey.
[Subjects and Methods] 124 consecutive epilepsy patients were enrolled and their
demographic variables and clinical characteristics recorded. The Short Form-36
questionnaire was completed independently by each participant. Short Form-36 dimensional
and composite scores were computed and scaled with data from an extensive survey of the
healthy population. [Results] Short Form-36 scores for physical dimensions were similar to
healthy values, but those for mental dimensions except for energy/vitality were remarkably
and significantly lower than normal. All Short Form-36 average scores for women were lower
than those for men and significantly so for mental health composite scores. Patients
responding well to treatment were aware of their improving health as measured by the
Change in Health score and had better dimensional scores than those with a poor response.
[Conclusion] Patients with epilepsy do not perceive impaired physical health status.
However, their mental health appears vulnerable, especially in women. Therefore, the major
burden in epilepsy is in the mental health category. A positive treatment response is also
an important determinant of the related quality of life measure.
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Affiliation(s)
- Fatma Karantay Mutluay
- Division of Physical Therapy and Rehabilitation, Faculty of Health Science, Istanbul Medipol University, Turkey
| | - Aysegul Gunduz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Anıl Tekeoglu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Semra Oguz
- Division of Physical Therapy and Rehabilitation, Faculty of Health Science, Marmara University, Turkey
| | - Seher Naz Yeni
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
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Quality of life and sense of coherence in young people and adults with uncomplicated epilepsy: A longitudinal study. Epilepsy Behav 2015; 47:127-31. [PMID: 25972130 DOI: 10.1016/j.yebeh.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of the study was, in a ten-year follow-up, to describe and explore potential changes in quality of life and sense of coherence in relation to gender differences among persons with epilepsy in the transition from adolescence to adulthood. MATERIALS AND METHODS A longitudinal study of sense of coherence (SOC) and quality of life with repeated measurement design (1999, 2004, and 2009) was conducted in a population of persons (n = 69) who were aged 13-22 years in 1999 and 23-33 years in 2009. The Quality-of-Life Index (QLI) and the Sense of Coherence (SOC) scale were used. RESULTS There was a significant decrease (p ≤ 0.001) in seizures compared with the 2004 results, mainly among the women (p = 0.003). When comparing the total QLI scores, no significant differences were found between the three data collections and there were no differences in total scores between men and women. There was a decrease in the SOC total score over the 10-year period study. Total SOC was significantly higher among those being 30-33 years old compared to those being 23-29 years old (p = 0.014) and among those having a driving license (p = 0.029) compared to those not having a driving license. CONCLUSIONS Both quality of life and sense of coherence are important for maintaining health and well-being. Promoting health and well-being requires effective high-quality multidisciplinary person-centered care.
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Development and validation of nomograms to provide individualised predictions of seizure outcomes after epilepsy surgery: a retrospective analysis. Lancet Neurol 2015; 14:283-90. [DOI: 10.1016/s1474-4422(14)70325-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Noda AH, Hermsen A, Berkenfeld R, Dennig D, Endrass G, Kaltofen J, Safavi A, Wiehler S, Carl G, Meier U, Elger CE, Menzler K, Knake S, Rosenow F, Strzelczyk A. Evaluation of costs of epilepsy using an electronic practice management software in Germany. Seizure 2015; 26:49-55. [DOI: 10.1016/j.seizure.2015.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 10/24/2022] Open
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Pompili M, Serafini G, Innamorati M, Montebovi F, Lamis DA, Milelli M, Giuliani M, Caporro M, Tisei P, Lester D, Amore M, Girardi P, Buttinelli C. Factors associated with hopelessness in epileptic patients. World J Psychiatry 2014; 4:141-149. [PMID: 25540729 PMCID: PMC4274586 DOI: 10.5498/wjp.v4.i4.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/01/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate factors related to hopelessness in a sample of epileptic patients, including measures of depression and quality of life (QOL).
METHODS: Sixty-nine participants were administered the following psychometric instruments: Beck Depression Inventory-II, Beck Hopelessness Scale (BHS), and QOL in Epilepsy (QOLIE)-89. Patients were dichotomized into two categories: those affected by epilepsy with generalized tonic-clonic seizures vs those having epilepsy with partial seizures.
RESULTS: The groups differed on the QOLIE Role Limitation/Emotional dimension. Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems than patients with other types of epilepsy (89.57 ± 25.49 vs 72.86 ± 36.38; t63 = -2.16; P < 0.05). All of the respondents reported moderate to severe depression, and 21.7% of patients with generalized seizures and 28.6% of patients with other diagnoses had BHS total scores ≥ 9 indicating a higher suicidal risk. The study did not control for years of the illness.
CONCLUSION: Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems compared to patients with other types of seizures. Patients at increased suicide risk as evaluated by the BHS were older than those who had a lower suicidal risk. Future studies are required to further investigate the impact of hopelessness on the outcome of epileptic patients.
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Kemmotsu N, Kucukboyaci NE, Leyden KM, Cheng CE, Girard HM, Iragui VJ, Tecoma ES, McDonald CR. Frontolimbic brain networks predict depressive symptoms in temporal lobe epilepsy. Epilepsy Res 2014; 108:1554-63. [PMID: 25223729 PMCID: PMC4194230 DOI: 10.1016/j.eplepsyres.2014.08.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/10/2014] [Accepted: 08/21/2014] [Indexed: 01/10/2023]
Abstract
Psychiatric co-morbidities in epilepsy are of great concern. The current study investigated the relative contribution of structural and functional connectivity (FC) between medial temporal (MT) and prefrontal regions in predicting levels of depressive symptoms in patients with temporal lobe epilepsy (TLE). Twenty-one patients with TLE [11 left TLE (LTLE); 10 right TLE (RTLE)] and 20 controls participated. Diffusion tensor imaging was performed to obtain fractional anisotropy (FA) of the uncinate fasciculus (UF), and mean diffusivity (MD) of the amygdala (AM) and hippocampus (HC). Functional MRI was performed to obtain FC strengths between the AM and HC and prefrontal regions of interest including anterior prefrontal (APF), orbitofrontal, and inferior frontal regions. Participants self-reported depression symptoms on the Beck Depression Inventory-II. Greater depressive symptoms were associated with stronger FC of ipsilateral HC-APF, lower FA of the bilateral UF, and higher MD of the ipsilateral HC in LTLE, and with lower FA of the contralateral UF in RTLE. Regression analyses indicated that FC of the ipsilateral HC-APF was the strongest contributor to depression in LTLE, explaining 68.7% of the variance in depression scores. Both functional and microstructural measures of frontolimbic dysfunction were associated with depressive symptoms. These connectivity variables may be moderating which patients present with depression symptoms. In particular, FC MRI may provide a more sensitive measure of depression-related dysfunction, at least in patients with LTLE. Employing sensitive measures of frontolimbic network dysfunction in TLE may help provide new insight into mood disorders in epilepsy that could eventually guide treatment planning.
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Affiliation(s)
- Nobuko Kemmotsu
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - N Erkut Kucukboyaci
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA; SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, San Diego, CA, USA.
| | - Kelly M Leyden
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA.
| | - Christopher E Cheng
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA.
| | - Holly M Girard
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, San Diego, CA, USA.
| | - Vicente J Iragui
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA.
| | - Evelyn S Tecoma
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, San Diego, CA, USA; Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA.
| | - Carrie R McDonald
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, San Diego, CA, USA.
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Rathore JS, Jehi LE, Fan Y, Patel SI, Foldvary-Schaefer N, Ramirez MJ, Busch RM, Obuchowski NA, Tesar GE. Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. Epilepsy Behav 2014; 37:215-20. [PMID: 25064739 PMCID: PMC4427235 DOI: 10.1016/j.yebeh.2014.06.030] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the accuracy and operating characteristics of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. METHODS Tertiary epilepsy center patients served as the study population, with 237 agreeing to structured interview using the Mini-International Neuropsychiatric Interview (MINI), a "gold standard" instrument developed for rapid diagnosis of neuropsychiatric disorders, including major depressive disorder (MDD); 172 also completed the PHQ-9, and 127 completed both the PHQ-9 and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) within two days of the MINI. Sensitivity, specificity, positive and negative predictive values, and areas under the ROC curves for each instrument were determined. Cut-points of 10 for the PHQ-9 and 15 for the NDDI-E were used, and ratings at or above the cut-points were considered screen-positive. The PHQ-9 was divided into cognitive/affective (PHQ-9/CA) and somatic (PHQ-9/S) subscales to determine comparative depression screening accuracy. RESULTS The calculated areas under the ROC curves for the PHQ-9 (n=172) and the PHQ-9/CA and PHQ-9/S subscales were 0.914, 0.924, and 0.846, respectively, with the PHQ-9 more accurate than the PHQ-9/S (p=0.002) but not different from the PHQ-9/CA (p=0.378). At cut-points of 10 and 15, respectively, the PHQ-9 had higher sensitivity (0.92 vs 0.87) but lower specificity (0.74 vs 0.89) compared with the NDDI-E. The areas under the ROC curves of the PHQ-9 and the NDDI-E showed similar accuracy (n=127; 0.930 vs 0.934; p=0.864). SIGNIFICANCE The PHQ-9 is an efficient and nonproprietary depression screening instrument with excellent accuracy validated for use in adult patients with epilepsy as well as multiple other medical populations.
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Affiliation(s)
- Jaivir S. Rathore
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Neurology and Rehabilitation, Neuropsychiatric Institute, University of Illinois Medical Center at Chicago (UIC), Illinois, U.S.A,Corresponding Author: Jaivir S. Rathore, M.D. 912 S. Wood St. 855N (M/C 769) UIC Chicago, IL 60612, U.S.A, Phone: +1-216-925-2499,
| | - Lara E. Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Youran Fan
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Sima I. Patel
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,MINCEP Epilepsy Care, University of Minnesota Medical Center, Minneapolis, Minnesota, U.S.A
| | - Nancy Foldvary-Schaefer
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Maya J. Ramirez
- Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Psychology Services, Tampa General Hospital, Tampa, Florida, U.S.A
| | - Robyn M. Busch
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Nancy A. Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - George E. Tesar
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A,Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
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Predictors of quality of life and their interrelations in Korean people with epilepsy: a MEPSY study. Seizure 2014; 23:762-8. [PMID: 25008245 DOI: 10.1016/j.seizure.2014.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE People with epilepsy (PWE) are more likely to have impaired quality of life (QOL) than the general population. We studied predictors of QOL and their interrelations in Korean PWE. METHODS Subjects who consecutively visited outpatient clinics in four tertiary hospitals and one secondary care hospital were enrolled. These subjects completed the Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), the Generalized Anxiety Disorder-7 (GAD-7), the Quality of Life in Epilepsy-10 (QOLIE-10), and the Korean version of Liverpool Adverse Event Profile (K-LAEP). We evaluated the predictors of QOL by multiple regression analyses and verified the interrelations between the variables using a structural equation model. RESULTS A total of 702 PWE were eligible for the study. The strongest predictor of the overall QOLIE-10 score was the K-LAEP score (β=-0.375, p<0.001), followed by the K-NDDI-E score (β=-0.316, p<0.001), seizure control (β=-0.152, p<0.001), household income (β=-0.375, p<0.001), and GAD-7 score (β=-0.119, p=0.005). These variables explained 68.7% of the variance in the overall QOLIE-31 score. Depression and seizure control had a bidirectional relationship and exerted direct effects on QOL. These factors also exerted indirect effects on QOL by provoking adverse effects of AEDs. Anxiety did not have a direct effect on QOL; it had only indirect effect through the adverse effects of AEDs. CONCLUSION Depression, anxiety, seizure control, and adverse effects of AEDs have complex interrelations that determine the QOL of PWE.
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Choi H, Hamberger MJ, Munger Clary H, Loeb R, Onchiri FM, Baker G, Hauser WA, Wong JB. Seizure frequency and patient-centered outcome assessment in epilepsy. Epilepsia 2014; 55:1205-12. [DOI: 10.1111/epi.12672] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Hyunmi Choi
- Department of Neurology; Columbia University; New York New York U.S.A
| | | | - Heidi Munger Clary
- Department of Neurology; Wake Forest University School of Medicine; Winston-Salem North Carolina U.S.A
| | - Rebecca Loeb
- Department of Psychiatry and Behavioral Sciences; Memorial Sloan-Kettering Cancer Center; New York New York U.S.A
| | | | - Gus Baker
- Department of Neurosciences; University of Liverpool; Liverpool United Kingdom
| | - W. Allen Hauser
- Department of Neurology; Columbia University; New York New York U.S.A
| | - John B. Wong
- Department of Medicine; Division of Clinical Decision Making; Tufts University School of Medicine; Boston Massachusetts U.S.A
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Milovanović M, Martinović Ž, Tošković O. Determinants of quality of life in people with epilepsy in Serbia. Epilepsy Behav 2014; 31:160-6. [PMID: 24424279 DOI: 10.1016/j.yebeh.2013.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/03/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed at finding determinants of quality of life in people with epilepsy (PWE) living in Belgrade, Serbia. METHOD In this study, we recruited consecutive adults with epilepsy attending our outpatient department. Adult patients (age range: 18-65years) of normal intelligence and without any progressive neurological disease or psychiatric disorder were included in the study. They completed the following questionnaires: QOLIE-31 Inventory (Serbian version), Beck's Depression Inventory-II, Beck's Anxiety Inventory, Symptom Check List-90, and Neurotoxicity Scale-II. Hierarchical multiple regression analysis was performed to assess the predictive effects of some factors on QOLIE-31 Inventory. RESULTS The mean QOLIE-31 score of 203 patients who completed the questionnaires was 70.64±17.74. Sociodemographic factors (age, sex, education, and employment) did not significantly predict QOLIE-31 score. Significant determinants of quality of life were clinical characteristics - seizure severity and etiology of epilepsy - accounting for 30.9% of the variance, depressive and anxiety symptoms accounting for 42.8% of the variance, and cognitive effects of antiepileptic drugs, accounting for 1.5% above other variables. CONCLUSIONS The results suggest that seizure severity and etiology of epilepsy, depressive and anxiety symptoms, and cognitive adverse medication effects are main determinants of quality of life in this population of PWE.
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Affiliation(s)
- Maja Milovanović
- Department for Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Palmotićeva 37, 11000 Belgrade, Serbia.
| | - Žarko Martinović
- Department for Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Palmotićeva 37, 11000 Belgrade, Serbia; Belgrade University Medical School, Dr Subotića 8, 11000 Belgrade, Serbia
| | - Oliver Tošković
- Faculty of Philosophy, Department for Psychology - Statistics, University of Belgrade, Čika Ljubina 18-20, 11000 Belgrade, Serbia
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Kemmotsu N, Kucukboyaci NE, Cheng CE, Girard HM, Tecoma ES, Iragui VJ, McDonald CR. Alterations in functional connectivity between the hippocampus and prefrontal cortex as a correlate of depressive symptoms in temporal lobe epilepsy. Epilepsy Behav 2013; 29:552-9. [PMID: 24176688 PMCID: PMC3876964 DOI: 10.1016/j.yebeh.2013.09.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/05/2013] [Accepted: 09/29/2013] [Indexed: 11/18/2022]
Abstract
Depression is a common comorbidity in temporal lobe epilepsy (TLE) that is thought to have a neurobiological basis. This study investigated the functional connectivity (FC) of medial temporal networks in depression symptomatology of TLE and the relative contribution of structural versus FC measures. Volumetric MRI and functional connectivity MRI (fcMRI) were performed on nineteen patients with TLE and 20 controls. The hippocampi and amygdalae were selected as seeds, and five prefrontal and five cingulate regions of interest (ROIs) were selected as targets. Low-frequency blood-oxygen-level-dependent signals were isolated from fcMRI data, and ROIs with synchronous signal fluctuations with the seeds were identified. Depressive symptoms were measured by the Beck Depression Inventory-II. The patients with TLE showed greater ipsilateral hippocampal atrophy (HA) and reduced FC between the ipsilateral hippocampus and the ventral posterior cingulate cortex (vPCC). Neither HA nor hippocampal-vPCC FC asymmetry was a robust contributor to depressive symptoms. Rather, hippocampal-anterior prefrontal FC was a stronger contributor to depressive symptoms in left TLE (LTLE). Conversely, right amygdala FC was correlated with depressive symptoms in both patient groups, with a positive and negative correlation in LTLE and right TLE (RTLE), respectively. Frontolimbic network dysfunction is a strong contributor to levels of depressive symptoms in TLE and a better contributor than HA in LTLE. In addition, the right amygdala may play a role in depression symptomatology regardless of the side of the epileptogenic focus. These findings may inform the treatment of depressive symptoms in TLE and inspire future research to help guide surgical planning.
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Affiliation(s)
- Nobuko Kemmotsu
- University of California San Diego Multimodal Imaging Laboratory, 8950 Villa La Jolla Dr., Suite C101, La Jolla, CA 92037, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
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Giovagnoli AR, Parente A, Villani F, Franceschetti S, Spreafico R. Theory of mind and epilepsy: what clinical implications? Epilepsia 2013; 54:1639-46. [PMID: 23808357 DOI: 10.1111/epi.12255] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Epilepsy can impair theory of mind (ToM), but the clinical significance of such a deficit is unknown. This study evaluated the influence of selective ToM deficits on self-appraisal, coping, and quality of life (QoL) in patients with focal epilepsy. METHODS Data were collected from 66 patients with temporal or frontal lobe epilepsy, and from 42 healthy controls. The Faux Pas Task (FPT), Multiple Ability Self-report Questionnaire (MASQ), Coping Responses Inventory-Adult (CRI-Adult), and World Health Organization QoL 100 (WHOQoL 100) evaluated ToM, self-rated cognitive abilities, coping to stressful events, and QoL. Different tests and inventories assessed other cognitive functions, depression, and anxiety. KEY FINDINGS Patients were impaired in the recognition and comprehension of social faux pas. The FPT scores contributed to predict the MASQ, CRI-Adult, and WHOQoL overall scores; the comprehension of others' mental states and interactions score exerted a prominent influence. SIGNIFICANCE In patients with focal epilepsy, selective ToM deficits may have clinical implications, with specific influence on self-appraisal, coping, and overall QoL. ToM evaluation may contribute in explaining some psychobehavioral difficulties and to plan nonpharmacological treatment.
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Affiliation(s)
- Anna Rita Giovagnoli
- Laboratory of Cognitive Neurology and Rehabilitation, Unit of Neurology and Neuropathology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
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Strzelczyk A, Haag A, Reese JP, Nickolay T, Oertel WH, Dodel R, Knake S, Rosenow F, Hamer HM. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany. Epilepsy Behav 2013; 27:433-8. [PMID: 23591262 DOI: 10.1016/j.yebeh.2013.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/09/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
Abstract
This study evaluated trends in the resource use of patients with active epilepsy over a 5-year period at an outpatient clinic of a German epilepsy center. Two cross-sectional cohorts of consecutive adults with active epilepsy were evaluated over a 3-month period in 2003 and 2008. Data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded using validated patient questionnaires. We enrolled 101 patients in 2003 and 151 patients in 2008. In both cohorts, 76% of the patients suffered from focal epilepsy, and the majority was on antiepileptic drug (AED) polytherapy (mean AED number: 1.7 (2003), 1.8 (2008)). We calculated epilepsy-specific costs of € 2955 in 2003 and € 3532 in 2008 per 3 months per patient. Direct medical costs were mainly due to anticonvulsants in 2003 (59.4% of total direct costs, 34.0% in 2008) and to hospitalization in 2008 (46.9% of total direct costs, 27.7% in 2003). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2008. Indirect costs of € 1689 and € 1847 were mainly due to early retirement (48.4%; 46.0% of total indirect costs in 2003; 2008), unemployment (26.1%; 24.2%), and days off due to seizures (25.5%; 29.8%). This study showed a shift in distribution of direct cost components with increased hospital costs as well as a cost-neutral increase in the prescription of 'newer' AEDs. The amount and distribution of indirect cost components remained unchanged.
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Affiliation(s)
- Adam Strzelczyk
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
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Tedrus GMDAS, Fonseca LC, Carvalho RM. Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:385-91. [DOI: 10.1590/0004-282x20130044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 12/12/2012] [Indexed: 11/22/2022]
Abstract
Objective To study socio-demographic and clinical aspects, as well as psychiatric co-morbidity that influence the quality of life of adult epileptic patients. Methods One hundred and thirty-two individuals diagnosed with epilepsy were evaluated from neurological/clinical and psychiatric points of view and by the Quality of Life in Epilepsy Inventory (QOLIE-31). Predictive factors for the QOLIE-31 scores were studied. Results The regression analyses indicated the existence of psychiatric co-morbidity (total score, seizure worry, emotional well-being, energy/fatigue, social function and cognitive function) and a greater seizure frequency (total score, cognitive function and energy/fatigue) as predictive factors for lower scores in the total QOLIE-31 score and in various dimensions. Abnormalities in the neurological exam and poly-therapy with anti-epileptic drugs were negative factors limited to one of the dimensions cognitive function and social function, respectively. Conclusion The presence of psychiatric co-morbidity and a greater seizure frequency were the main factors influencing the quality of life in epileptic patients as evaluated by QOLIE-31.
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Kolakowsky-Hayner SA, Wright J, Englander J, Duong T, Ladley-O'Brien S. Impact of late post-traumatic seizures on physical health and functioning for individuals with brain injury within the community. Brain Inj 2013; 27:578-86. [PMID: 23472705 DOI: 10.3109/02699052.2013.765595] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To better characterize, describe and highlight issues that individuals with TBI and active LPTS may face in their daily lives. DESIGN Prospective multi-centre mixed method qualitative and quantitative interview. PARTICIPANTS Twenty-five individuals, 5-13 years post-injury, who had reported having LPTS and TBI. MEASURES Disability Rating Scale (DRS); Supervision Rating Scale (SRS); Glasgow Outcome Scale-Extended (GOS-E); Perceived Stress Scale (PSS); Craig Handicap Assessment Reporting Technique-Short Form (CHART-SF) sub-scales: Physical Independence, Cognitive Independence, Mobility, Occupation, Social Integration; and Craig Hospital Inventory of Environmental Factors (CHIEF); and qualitative interview questions pertaining to management of the seizure disorder and its effect on the individual's health, function, community integration and participation. RESULTS Data are presented regarding seizure activity and management; return to driving post-seizure; coping and participation; and standardized outcome measures. CONCLUSIONS Individuals with TBI and LPTS are at a double-barrelled disadvantage regarding ongoing physical, cognitive, psychosocial and reintegration issues following brain injury and epilepsy. Clearer clinical guidelines and treatment strategies need to be developed to help ameliorate these ongoing issues. Additional research is needed to identify what the rehabilitation community can do to continue to facilitate people living safely and independently.
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Epps SA, Tabb KD, Lin SJ, Kahn AB, Javors MA, Boss-Williams KA, Weiss JM, Weinshenker D. Seizure susceptibility and epileptogenesis in a rat model of epilepsy and depression co-morbidity. Neuropsychopharmacology 2012; 37:2756-63. [PMID: 22871911 PMCID: PMC3499730 DOI: 10.1038/npp.2012.141] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although a strong co-morbidity exists clinically between epilepsy and depression, the cause of this co-morbidity remains unknown, and a valid animal model is crucial for the identification of underlying mechanisms and the development of a screening tool for novel therapies. Although some rodent models of epilepsy have been reported to display behaviors relevant to affective disorders, the seizure susceptibility of animals prone to depression-like behavior has not been characterized. Toward this end, we assessed several forms of seizure sensitivity and epileptogenesis in rats selectively bred for vulnerability (Swim Lo-Active; SwLo) or resilience (Swim High-Active; SwHi) to depression-like phenotypes. The SwLo rats exhibit decreased motor activity in a swim test and other depression-like phenotypes, whereas the SwHi rats display increased motor activity in a swim test. SwLo rats exhibited a decreased latency to limbic motor seizures following acute pilocarpine administration in the absence of differences in pilocarpine pharmacokinetics, and also had a decreased threshold to tonic seizures induced by electroshock. Approximately half of the SwLo rats, but none of the SwHi rats, had spontaneous limbic motor seizures 5 weeks following pilocarpine-induced status epilepticus. While the number of stimulations required to achieve full amygdala and hippocampal electrical kindling were similar in the two rat lines, SwLo rats had a lower final hippocampal kindling threshold and more wet dog shakes during both amygdala and hippocampal kindling. Combined, these results indicate that SwLo rats are a model of epilepsy and depression co-morbidity that can be used for investigating underlying neurobiological and genetic mechanisms and screening novel therapeutics.
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Affiliation(s)
- S Alisha Epps
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kroshona D Tabb
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Sharon J Lin
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexa B Kahn
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Martin A Javors
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Jay M Weiss
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - David Weinshenker
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA,Department of Human Genetics, Emory University School of Medicine, Whitehead 301, 615 Michael St, Atlanta, GA 30322, USA, Tel: +404 727 3106, Fax: +404 727 3949, E-mail:
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Predictors of quality of life in patients with refractory mesial temporal lobe epilepsy. Epilepsy Behav 2012; 25:208-13. [PMID: 23032134 DOI: 10.1016/j.yebeh.2012.06.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/05/2012] [Accepted: 06/23/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE The identification of variables associated with health-related quality of life (HRQoL) in patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) would improve surgical decision-making and post-operatory follow-up in this group of patients. METHODS We analyzed the independent association between the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) of 81 consecutive patients with refractory MTLE-HS. The clinical, demographic, radiological and electrophysiological variables were analyzed by multiple linear regression analysis. KEY FINDINGS Approximately 36% (adjusted R(2)=0.36; R coefficient=0.66) of the QOLIE-31 overall score variance was explained by the history of initial precipitant injury, family history of epilepsy, disease duration, age of epilepsy onset, seizure frequency and presence of psychiatric axis-II diagnosis. The variance of QOLIE-31 sub-scales was: seizure worry=7%; overall QOL=11%; emotional well-being=32%; energy/fatigue=38%; cognitive function=13%; medication effects=7%; social function=13% (R coefficient between 0.30 and 0.65). SIGNIFICANCE The pre-surgical variables studied had relatively low prediction capacity for the overall QOLIE-31 score and its sub-scales in this set of Brazilian patients with refractory MTLE-HS.
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Rampling J, Mitchell AJ, Von Oertzen T, Docker J, Jackson J, Cock H, Agrawal N. Screening for depression in epilepsy clinics. A comparison of conventional and visual-analog methods. Epilepsia 2012; 53:1713-21. [DOI: 10.1111/j.1528-1167.2012.03571.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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