51
|
Mota SM, Amaral de Castro L, Riedel PG, Torres CM, Bragatti JA, Brondani R, Secchi TL, Sanches PRS, Caumo W, Bianchin MM. Home-Based Transcranial Direct Current Stimulation for the Treatment of Symptoms of Depression and Anxiety in Temporal Lobe Epilepsy: A Randomized, Double-Blind, Sham-Controlled Clinical Trial. Front Integr Neurosci 2021; 15:753995. [PMID: 34955774 PMCID: PMC8693513 DOI: 10.3389/fnint.2021.753995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
We conducted a double-blind randomized clinical trial in order to examine the effects and the safety of home-based transcranial direct current stimulation (tDCS) on depressive and anxious symptoms of patients with temporal lobe epilepsy (TLE). We evaluated 26 adults with TLE and depressive symptoms randomized into two different groups: active tDCS (tDCSa) and Sham (tDCSs). The patients were first submitted to 20 sessions of tDCS for 20 min daily, 5 days a week for 4 weeks and then received a maintenance tDCS application in the research laboratory once a week for 3 weeks. The intensity of the current was 2 mA, applied bilaterally over the dorsolateral prefrontal cortex, with the anode positioned on the left side and the cathode on the right side. Participants were evaluated on days 1, 15, 30, and 60 of the study using the Beck Depression Inventory II (BDI). A follow-up evaluation was performed 1 year after the end of treatment. They were also evaluated for quality of life and for anxious symptoms as secondary outcomes. The groups did not differ in clinical, socioeconomic or psychometric characteristics at the initial assessment. There was no statistically significant difference between groups regarding reported adverse effects, seizure frequency or dropouts. On average, between the 1st and 60th day, the BDI score decreased by 43.93% in the active group and by 44.67% in the Sham group (ΔBDIfinal – initial = −12.54 vs. −12.20, p = 0.68). The similar improvement in depressive symptoms observed in both groups was attributed to placebo effect and interaction between participants and research group and not to tDCS intervention per se. In our study, tDCS was safe and well tolerated, but it was not effective in reducing depressive or anxiety symptoms in patients with temporal lobe epilepsy. Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT03871842].
Collapse
Affiliation(s)
- Suelen Mandelli Mota
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Carolina Machado Torres
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro para Tratamento de Epilepsia Refratária (CETER), Basic Research and Advanced Investigations in Neuroscience (BRAIN), Serviço de Neurologia do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - José Augusto Bragatti
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro para Tratamento de Epilepsia Refratária (CETER), Basic Research and Advanced Investigations in Neuroscience (BRAIN), Serviço de Neurologia do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rosane Brondani
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro para Tratamento de Epilepsia Refratária (CETER), Basic Research and Advanced Investigations in Neuroscience (BRAIN), Serviço de Neurologia do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Thais Leite Secchi
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Wolnei Caumo
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Engenharia Biomédica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Dor & Neuromodulação, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marino Muxfeldt Bianchin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro para Tratamento de Epilepsia Refratária (CETER), Basic Research and Advanced Investigations in Neuroscience (BRAIN), Serviço de Neurologia do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
52
|
Wu J, Ding W, Ye X, Wei Q, Lv X, Tang Q, Tian Y, Wang K, Jiang Y. Interictal Activity Is Associated With Slower Binocular Rivalry in Idiopathic Generalized Epilepsy. Front Neurol 2021; 12:720126. [PMID: 34867711 PMCID: PMC8634877 DOI: 10.3389/fneur.2021.720126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Perceptual alternations evoked by binocular rivalry (BR) reflect cortical dynamics strongly dependent on the excitatory-inhibitory balance, suggesting potential utility as a biomarker for epileptogenesis. Therefore, we investigated the characteristics of BR in patients with idiopathic generalized epilepsy (IGE) and potential associations with clinical variables. Methods: Sixty-two healthy controls (HCs) and 94 IGE patients completed BR task. Perceptual alternation rates were compared between HC and IGE groups as well as among the HC group and IGE patients stratified according to the presence or absence of interictal activity on the ambulatory electroencephalogram (EEG), termed the abnormal ambulatory EEG group (AB-AEEG, n = 64) and normal ambulatory EEG group (N-AEEG, n = 30), respectively. Results: The IGE patients demonstrated a slower rate of BR perceptual alternation than HC subjects (t = -4.364, p < 0.001). The alternation rate also differed among the HC, AB-AEEG, and N-AEEG groups (F = 44.962, df = 2, p < 0.001), and post hoc comparisons indicated a significantly slower alternation rate in the AB-AEEG group compared with the N-AEEG and HC groups (0.28 vs. 0.46, and 0.43 Hz). Stepwise linear regression revealed positive correlations between the BR alternation rate and both the ambulatory EEG status (β, 0.173; standard error, 0.022 p < 0.001) and Montreal Cognitive Assessment score (β, 0.013; standard error, 0.004; p = 0.003). Receiver operating characteristic curve analysis of the BR alternation rate distinguished AB-AEEG from N-AEEG subjects with 90.00% sensitivity and 76.90% specificity (area under the curve = 0.881; 95% confidence interval = 0.801- 0.961, cut-off = 0.319). Alternatively, Montreal Cognitive Assessment score did not accurately distinguish AB-AEEG from N-AEEG subjects and the area under the receiver operating characteristic curve combining the BR alternation rate and Montreal Cognitive Assessment score was not markedly larger than that of the BR alternation rate alone (0.894, 95% confidence interval = 0.822-0.966, p < 0.001). K-fold cross-validation was used to evaluate the predictive performance of BR alternation rate, MoCA score, and the combination of both, which yielded average AUC values of 0.870, 0.584 and 0.847, average sensitivity values of 89.36, 92.73, and 91.28%, and average specificity values of 62.25, 13.42, and 61.78%, respectively. The number of interictal epileptiform discharges was significantly correlated with the alternation rate in IGE patients (r = 0.296, p = 0.018). A forward stepwise linear regression model identified the number of interictal epileptiform discharges (β, 0.001; standard error, 0.001; p = 0.025) as an independent factor associated with BR alternation rate in these patients. Conclusion: These results suggest that interictal epileptiform discharges are associated with disruptions in perceptual awareness, and that the BR may be a useful auxiliary behavioral task to diagnosis and dynamically monitor IGE patients with interictal discharge.
Collapse
Affiliation(s)
- Jiaonan Wu
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurology, Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Ding
- Department of Nephrology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xing Ye
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qiang Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Xinyi Lv
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Qiqiang Tang
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurology, Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Yubao Jiang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| |
Collapse
|
53
|
Patient Health Questionnaire (PHQ-9): A depression screening tool for people with epilepsy in Vietnam. Epilepsy Behav 2021; 125:108446. [PMID: 34839244 DOI: 10.1016/j.yebeh.2021.108446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is a common mental disorder in people with epilepsy. Depression has a negative impact on medical and surgical treatment of epilepsy thus affecting the quality of life. Despite its high prevalence, depression has been under-recognized and treated improperly. It may also lead to missed work, increased healthcare system utilization, and higher direct medical costs. OBJECTIVES This study aimed to evaluate the accuracy of the Vietnamese Patient Health Questionnaire (PHQ-9) as a screening tool for depression in people with epilepsy. METHODS This cross-sectional study was conducted prospectively at epilepsy clinic at Nguyen Tri Phuong hospital, Ho Chi Minh City, Viet Nam from December 2019 to March 2020. A total of 91 adult people with epilepsy were recruited. After completing the Vietnamese PHQ-9 questionnaires, each participant was interviewed in a structured clinical interview for DSM-5 (SCID-5) to establish a diagnosis of major depressive disorder. The diagnostic accuracy of the PHQ-9 was assessed using diagnostic efficiency statistics compared with the gold standard structured interview. RESULTS The prevalence of major depression in this sample was 25.3%. The areas under receiver operating characteristic (ROC) curve index of PHQ-9 had an estimated value of 0.91. The PHQ-9 at a cutoff point of 8 had the great overall balance of sensitivity (87.0%) and specificity (82.4%). At the cutoff point of 10, PHQ-9 had a higher specificity of 94.1%, but a lower sensitivity of 78.0%. CONCLUSIONS The Vietnamese version PHQ-9 is an efficient and valid screening tool for depression in people with epilepsy in clinic settings.
Collapse
|
54
|
Ma XP, Li YP, Yang R, Zhou D, Li JM. Challenges of patients with epilepsy and measures for improving epilepsy care in western China: A qualitative study. Epilepsy Res 2021; 178:106788. [PMID: 34844090 DOI: 10.1016/j.eplepsyres.2021.106788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this qualitative study was to explore the challenges that patients with epilepsy (PWEs) face and the opportunities or areas where changes in nursing care may improve epilepsy care in western China. METHODS Semi-structured interviews with open-ended questions based on a review of the literature were conducted at the epilepsy center of a tertiary hospital in western China. A total of 18 PWEs, 18 caregivers and 11 neurology nurses were interviewed by using purposive sampling. The data were transcribed verbatim, and a content analysis was used to conduct the framework analysis. RESULTS Three key themes were identified, namely, the impact of epilepsy, barriers to epilepsy management, and measures in nursing care for improving epilepsy care. Psychological stress, the side effects of drugs and accidental injury related to seizures were reported to be the main negative impacts on patients. Limited knowledge about epilepsy, poor adherence to therapy, and a lack of effective communication between patients and medical staff were the major barriers to epilepsy management. Strengthening health education, assessing the frequency and type of seizures, screening for psychological disorders and mental intervention, and maintaining continuity of care were identified as crucial measures for nurses to improve epilepsy care. CONCLUSIONS This study highlights the challenges among PWEs and opportunities for improving the quality of epilepsy care in western China. Limited knowledge and poor drug adherence are the main barriers to epilepsy management, which might be improved by more health education and continuing care provided by nurses. Assessing seizures, screening for psychological disorders and providing appropriate psychological care would help improve epilepsy care.
Collapse
Affiliation(s)
- Xue-Ping Ma
- West China School of Nursing, Sichuan University/ Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Yin-Ping Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Rong Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Jin-Mei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
55
|
Hussain M, Rashid H, Katyal J. Response to sertraline and antiepileptic drugs in pentylenetetrazole kindling in rats. Brain Res 2021; 1771:147645. [PMID: 34480951 DOI: 10.1016/j.brainres.2021.147645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
Anti-epileptic drugs (AEDs) are the mainstay of epilepsy treatment but these may be a potential risk factor for behavioral disturbances particularly depression which requires treatment. In this study, the effect of antidepressant sertraline (SRT) in combination with AEDs sodium valproate (SV) and levetiracetam (LEV) on seizures, cognitive impairment and oxidative stress in rats was evaluated. After administration of 24th injection of pentylenetetrazole (PTZ), 77.8% rats were kindled. Administration of SRT showed no protective effect on kindling development while SV was 100% protective. With LEV 42.9% were kindled. On combining SRT with SV or LEV 25% and 20% rats were kindled. A significant increase in latency to reach platform zone in Morris water maze(MWM), and increased transfer latencies in Elevated plus maze(EPM) was observed in PTZ kindled rats as compared to normal control on day 49 and when LEV was combined with SRT. In EPM test, however none of the drug treatments had any effect on transfer latencies except LEV pretreated kindled group. In Passive avoidance (PA) test, kindling was associated with a significant decrease in retention time(p = 0.018) while LEV and SV had no effect. The PTZ kindled rats showed significantly higher malondialdehyde(MDA) levels in brain hippocampus(p = 0.0286) while both SRT and SV were associated with significantly lower MDA levels as compared to kindled control group. In case of glutathione (GSH), kindling had no significant effect. The use of sertraline for depression in persons with epilepsy on AEDs needs to be carefully evaluated and monitored due to likelihood of individual variation.
Collapse
Affiliation(s)
- Md Hussain
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Haroon Rashid
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jatinder Katyal
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
| |
Collapse
|
56
|
Tan JK, Khoo CS, Beh HC, Hod R, Baharudin A, Yahya WNNW, Tan HJ. Prevalence and associated risk factors of undiagnosed depression among people with epilepsy in a multiethnic society. Epilepsy Res 2021; 178:106772. [PMID: 34763265 DOI: 10.1016/j.eplepsyres.2021.106772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/17/2021] [Accepted: 09/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Depression is the most frequent psychiatric comorbidity of epilepsy. However, clinicians often neglect to screen for depressive symptoms among patients with epilepsy and, therefore, fail to detect depression. Many studies have described the risks associated with depression in patients with epilepsy, but few studies have elaborated whether these risks are similar in those with undiagnosed depression, especially in a multiethnic community. METHODS In the present cross-sectional study conducted at a tertiary teaching hospital, we aimed to investigate the prevalence and associated risk factors of undiagnosed depression in patients with epilepsy. We recruited patients with epilepsy aged 18-65 years after excluding those with background illnesses that may have contributed to the depressive symptoms. In total, 129 participants were recruited. We collected their demographic and clinical details before interviewing them using two questionnaires-the Neurological Disorders Depression Inventory for Epilepsy and Beck's Depression Inventory-II. Subsequently, if a participant screened positive for depression, the diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders questionnaire, and a psychiatric clinic referral was offered. RESULTS Among the 129 participants, 9.3 % had undiagnosed major depressive disorder, and there was a female preponderance (66.7 %). The risk factors for undiagnosed depression among patients with epilepsy included low socioeconomic background (p = 0.026), generalized epilepsy (p = 0.036), and temporal lobe epilepsy (p = 0.010). Other variables such as being underweight and unmarried were more common among patients diagnosed with depression than without but no statistically significant relationship was found. CONCLUSION The prevalence of undiagnosed depression among patients with epilepsy was higher than that in population-based studies conducted in Western countries. Although questionnaires to screen for depression are widely available, some clinicians rarely use them and, therefore, fail to identify patients who may benefit from psychosocial support and treatment that would improve their disease outcomes and quality of life. The present study indicated that clinicians should use screening questionnaires to identify undiagnosed depression in people with epilepsy.
Collapse
Affiliation(s)
- Juen Kiem Tan
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ching Soong Khoo
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hui Chien Beh
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Azlin Baharudin
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Wan Nur Nafisah Wan Yahya
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hui Jan Tan
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| |
Collapse
|
57
|
Prevalence of depression and associated factors among patients with epilepsy at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019. PLoS One 2021; 16:e0257942. [PMID: 34695130 PMCID: PMC8544874 DOI: 10.1371/journal.pone.0257942] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/14/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Depression is a commonly overwhelming problem among patients with epilepsy which compromises their quality of life especially in developing countries. Previously limited studies were conducted using Becks Depression Inventory tool in Ethiopia. The aim of this study’s objective was to determine the prevalence of depression and associated factors among patients with epilepsy. Methods Institution based cross-sectional study was employed at the University of Gondar Comprehensive Specialized Hospital from March 01–30, 2019.A total of 370 participants were selected using an interview administered structured questionnaire. Hospital Anxiety and Depression Scale was used to assess the prevalence of depression.Multivariable logistic regression analysis was done to investigate potential predictors and variables with a P-value of < 0.05 and a 95% confidence interval were considered statistically significant. Results A total of 370 study participants participated with a response rate of 92%. From the total respondents 37% experienced depression. Perceived stigma (AOR = 3.89, CI: 2.27, 6.68), educational status (AOR = 0.48, CI: 0.25, 0.92), residence (AOR = 0.5, CI: 0.28, 0.89), frequency of seizure (AOR = 2.07, CI: 1.01, 4.23) and social support (AOR = 2.73, CI: 1.41–5.31) were significantly associated with depression status. Conclusion This study revealed that prevalence of depression among Epileptic patients was high. Perceived stigma, educational status, residence, frequency of seizure and social support were significantly associated with depression status. Thus, health care workers better to give more emphasis to patients with perceived stigma, higher number of seizure frequency and to those with poor level of social support.
Collapse
|
58
|
Basaran S, Tas Hİ. Predictive factors of quality of life in temporal and extratemporal lobe epilepsy: association with affective temperament profiles and psychiatric comorbidities. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:799-807. [PMID: 34669818 DOI: 10.1590/0004-282x-anp-2020-0437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Investigating predictive factors of reduced quality of life (QOL) of patients and their association with focal epilepsy can improve management and treatment strategies. OBJECTIVE This study aimed to investigate the relationship between affective temperaments, depression, anxiety, disease characteristics, and QOL and to explore the predictors of QOL in patients with temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). METHODS A total of 50 patients with TLE, 51 patients with ETLE, and 70 controls were enrolled. Affective temperaments were evaluated using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A). QOL was assessed by the Short-Form Health Survey (SF-36). Beck Depression Inventory and Beck Anxiety Inventory were used to explore depression and anxiety severity, respectively. RESULTS Compared with the controls, patients with TLE and ETLE had significantly higher scores on all TEMPS-A scales, except on hyperthymic temperament. All the SF-36 subscale scores were lower in the TLE and ETLE groups. Linear regression analysis revealed that depressive symptoms, anxiety, depressive and irritable temperament, and seizure frequency were significant predictors of QOL in TLE. Patients with ETLE with temperamental disturbances, depressive symptoms, and polytherapy had a poorer QOL. CONCLUSIONS Affective temperaments, psychiatric disorders, and clinical factors may predict impaired QOL in patients with TLE and ETLE. Further studies are needed to identify predictors of QOL in various epilepsy subtypes.
Collapse
Affiliation(s)
- Sehnaz Basaran
- Kocaeli Derince Education and Research Hospital, Department of Neurology, Kocaeli, Turkey
| | - Halil İbrahim Tas
- Canakkale Onsekiz Mart University Medicine Faculty, Department of Psychiatry, Canakkale, Turkey
| |
Collapse
|
59
|
Zhong R, Chen Q, Li M, Lu Y, Zhao Q, Zhang X, Lin W. Factors contributing to comorbid depressive symptoms in adult people with newly diagnosed epilepsy: A 12-month longitudinal study. Epilepsy Behav 2021; 124:108326. [PMID: 34619545 DOI: 10.1016/j.yebeh.2021.108326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/04/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to investigate the point prevalence of comorbid depressive symptoms from the time of newly diagnosed epilepsy to 12 months and to identify the factors contributing to comorbid depressive symptoms over a 12-month period in patients with newly diagnosed epilepsy (PWNDE). METHODS A consecutive cohort of PWNDE from the First Hospital of Jilin University was recruited. Depressive symptoms were evaluated using the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy scale (C-NDDI-E). Multivariate stepwise logistic regression models were used to confirm the factors contributing to depressive symptoms in patients. RESULTS The point prevalence of depressive symptoms among PWNDE slightly decreased from 24.8% at baseline to 22.3% at 12 months. A MoCA score < 26 was identified as an independent risk factor contributing to depressive symptoms at baseline (OR = 2.419, 95% CI: 1.093-5.350, P = 0.029) and at 12 months (OR = 3.007, 95% CI: 1.223-7.390, P = 0.016). The adjusted OR for depressive symptoms in female patients was 0.365 (95% CI: 0.171-0.779, P = 0.009) compared with male patients. Depressive symptoms at baseline (OR = 4.539, 95% CI: 1.973-10.445, P < 0.001) were identified as significant predictors of depressive symptoms at 12 months. CONCLUSION There was a slight decrease in the prevalence of comorbid depressive symptoms in PWNDE over the 12-month period after epilepsy diagnosis. Cognitive impairment and baseline depressive symptoms were independent risk factors for comorbid depressive symptoms at 12 months.
Collapse
Affiliation(s)
- Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qingling Chen
- Department of Hepatology, Tianjin Medical University, Tianjin Second People's Hospital, Tianjin, China
| | - Mengmeng Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yingxue Lu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qian Zhao
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
60
|
Boddu VK, Rebello A, Chandrasekharan SV, Rudrabhatla PK, Chandran A, Ravi S, Unnithan G, Menon RN, Cherian A, Radhakrishnan A. How does "locus of control" affect persons with epilepsy? Epilepsy Behav 2021; 123:108257. [PMID: 34425327 DOI: 10.1016/j.yebeh.2021.108257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/24/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Locus of control (LOC) is the degree to which people believe that they have control over the outcome of events in their lives. A person's locus can be internal, external, or chance. A person with internal locus of control believes that one can control one's own life. A person with external locus of control believes that his life is controlled by external factors or people over which he has no influence. A person with chance locus of control believes that fate, chance, or luck controls his own life. The aim of the current study was to determine the health locus of control, anxiety, and depression levels in persons with epilepsy (PWE) and to assess whether locus of control has relation to anxiety, depression, and seizure control. METHODS Patients aged 18 years or older with a history of epilepsy for at least 1 year were recruited from the outpatient epilepsy clinic or from the inpatient epilepsy monitoring unit at SCTIMST, Trivandrum from January 2019 to May 2020. Patients filled the questionnaire form consisting of demographic data, age of onset of seizures, present seizure control, and the current antiepileptic drugs. The Hospital Anxiety and Depression (HAD) scale was used to estimate the level of anxiety and depression in these patients. The Form-C of the Multidimensional Health Locus of Control (MHLC) scale was used to evaluate the health locus of control. Healthy controls aged 18 years or older and free of any chronic disease or psychiatric illness were also recruited. They were asked to fill the questionnaire forms with basic demographic data. HAD scale was used to estimate the level of anxiety and depression and form-C of MHLC was used to evaluate the health locus of control in the healthy controls. The mean scores of anxiety, depression, and locus of control were compared between the two groups. RESULTS A total of 170 participants were recruited which consisted of 100 PWE and 70 healthy controls. The mean anxiety and depression scores were 8.13(SD = 4.23) and 5.85(SD = 3.66) in the PWE group and 6.75(SD = 3.39) and 4.14(SD = 2.96) in the control group, respectively. The mean internal, external, and chance LOC scores were 24.95(SD = 10.92), 26.94(SD = 4.96), and 24.41(SD = 6.46) in the PWE group; and 29.44(SD = 5.62), 26.53(SD = 5.79), and 19.9(SD = 7.13) in the control group, respectively. Persons with epilepsy had higher chance LOC scores and lower internal LOC scores compared to controls (p = 0.00003, p < 0.00001 respectively). There were no differences in the external LOC scores between the two groups (p = 0.620). Persons with epilepsy with some level of anxiety had lower internal LOC scores compared to patients with no anxiety (p = 0.04). PWE with poor seizure control had higher external LOC score and lower internal LOC scores which however did not reach statistical significance. Persons with epilepsy with poor seizure control had higher anxiety and depression scores. CONCLUSIONS Persons with epilepsy had low perceptions of internal and strong perceptions of chance health locus of control. This means that PWE feel that luck plays an important role in their disease control. This information is important in the counseling of persons with epilepsy.
Collapse
Affiliation(s)
- Vijay Kumar Boddu
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Alex Rebello
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Soumya V Chandrasekharan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Pavan Kumar Rudrabhatla
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anuvitha Chandran
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Swathy Ravi
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Gopeekrishnan Unnithan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ramshekhar N Menon
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ajith Cherian
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ashalatha Radhakrishnan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| |
Collapse
|
61
|
Vacca M, Fernandes M, Spanetta M, Placidi F, Izzi F, Lombardo C, Mercuri NB, Liguori C. Depressive symptoms in patients with epilepsy and clinically associated features in a single tertiary center. Neurol Sci 2021; 43:1965-1974. [PMID: 34528181 PMCID: PMC8860796 DOI: 10.1007/s10072-021-05589-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Although depressive symptoms are the most common psychiatric comorbidity in epilepsy, they remain underestimated and untreated in a large proportion of patients. The purpose of this study was to evaluate depression severity and related clinical features in people with epilepsy using a well-reliable self-report index of mood, the Beck Depression Inventory-II (BDI-II). One-hundred seventeen adult patients with epilepsy were recruited from a tertiary epilepsy center and completed the BDI-II. A single-item analysis of the 21 questions of the BDI-II was computed and differences between women and men in each depressive symptom were evaluated. Correlation and regression analyses were used to identify clinical features associated with the severity of depression. Results showed gender differences in some items, with women reporting overall higher depression severity than men. The most common symptoms regarded domains of sleeping patterns, tiredness, and loss of energy. Regression evidence suggested that being female, having an epilepsy duration < 10 years, as well as being treated with psychotropic drugs and reporting generalized seizure, were associated with higher depression severity. Despite its cross-sectional nature, this study reinforces the importance of investigating and possibly treating depressive symptoms in adult patients with epilepsy, since they negatively impact well-being, daytime activities, and sleep. Further studies identifying pharmacological and non-pharmacological treatments for depression in epilepsy need to be planned.
Collapse
Affiliation(s)
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Spanetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Placidi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Francesca Izzi
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | | | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.,IRCSS Santa Lucia Foudantion, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. .,Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.
| |
Collapse
|
62
|
Bhoopathy RM, Arthy B, Vignesh SS, Ruckmani S, Srinivasan AV. Involvement of Incomplete Hippocampal Inversion in Intractable Epilepsy: Evidence from Neuropsychological Studies. Neurol India 2021; 69:842-846. [PMID: 34507399 DOI: 10.4103/0028-3886.323886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The age of onset of seizure, seizure types, frequency of seizure, structural abnormalities in the brain, and antiepileptic medication (polytherapy) causes increased incidence of anxiety and depression in intractable epilepsy patients. Aim To compare the anxiety and depression levels in intractable epileptic patients with structural abnormalities [malformations of cortical development (MCD) and incomplete hippocampal inversion (IHI)] and without structural abnormalities. Materials and Methods Participants were selected from (239 males and 171 females) intractable epilepsy patients. They were grouped into four groups; Group 1: 51 nonepileptic age-matched controls, Group 2: 41 intractable epilepsy patients without any brain abnormality, Group 3: 17 intractable epilepsy patients with MCD, and Group 4: 30 intractable epilepsy patients with isolated IHI. Neuropsychiatric tools used were Multiphasic Personality Questionnaire and Weschlers Adult Intelligence Scale to assess anxiety, depression, and intelligence. Groups were classified using 1.5T conventional magnetic resonance imaging and hippocampal volumetric studies. Group comparison design was used. Results Demographic variables of intractable epilepsy, including seizure types, the frequency of seizure, the age of seizure onset, and antiepileptic drug therapies, did not show significant association between the groups using Chi-square P value. Analysis of variance showed significant anxiety and depression in epileptic patients than the control group (P < 0.01). Post hoc analysis using Tukey's B test showed significant difference in anxiety and depression scores between group value. In group 3 and 4, anxiety scores were significantly different but not depression scores. Conclusion The present study concludes high prevalence of anxiety and depression in intractable seizure. Anxiety is observed predominantly when there is IHI along with depression. We emphasize the need to identify IHI in intractable epilepsy and assess anxiety and depression to treat them effectively.
Collapse
Affiliation(s)
- R M Bhoopathy
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| | - B Arthy
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| | - S S Vignesh
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Smitha Ruckmani
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| | - A V Srinivasan
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| |
Collapse
|
63
|
Andersson K, Shadman A, Strang S. Trustful communication in the medical encounter: Perspectives of immigrated people with epilepsy. Chronic Illn 2021; 17:159-172. [PMID: 31072139 DOI: 10.1177/1742395319846254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Foreign-born people with epilepsy carry two mutually independent risk factors for poor health. While epilepsy increases the need for trust and clear communication, minority status presents additional barriers in communication, causing misconceptions, inadequate treatment and increased suffering. OBJECTIVES This study aimed to explore experiences of communication in the medical encounter from the perspectives of foreign-born people with epilepsy. METHODS A qualitative approach was applied. Twenty semi-structured in-depth interviews were conducted, recorded, transcribed verbatim and analyzed using manifest and latent content analysis. RESULTS Within the main theme, "Trustful communication in unpredictable terms of life," three subthemes appeared: "Social struggle overshadowing the epilepsy condition"; "Reliable health consultations as a key to feeling safe" and "Addressing 'the real problem' in the medical encounter." A reduced social network due to migration, together with fears related to epilepsy, seems to increase the need for immediate access to health consultations and the need to be listened to. Patients' narratives shed light on multiple social, medical and psychological events that may present reasons for the lack of medical adherence or missed booked appointments. DISCUSSION A respectful approach, listening and confirming the normalcy of epilepsy events seem fundamental for trustful communication in the context of epilepsy, regardless of a patient's culture or country of origin.
Collapse
Affiliation(s)
| | | | - Susann Strang
- Angered Hospital, Angered, Sweden.,Institute of Caring Sciences and Health, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
64
|
Li XL, Tang CY, Wang S, Zhao M, Wang XF, Li TF, Qi XL, Luan GM, Guan YG. Regulation of TWIK-related K + channel 1 in the anterior hippocampus of patients with temporal lobe epilepsy with comorbid depression. Epilepsy Behav 2021; 121:108045. [PMID: 34116339 DOI: 10.1016/j.yebeh.2021.108045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/11/2021] [Accepted: 04/30/2021] [Indexed: 02/08/2023]
Abstract
Epilepsy with comorbid depression has recently attracted increasing attention. Temporal lobe epilepsy (TLE) may represent an increased risk of developing depression, especially if the seizures do not generalize. The two-pore domain potassium channel-TWIK-related K+ channel (TREK-1) plays important roles in both epilepsy and depression. However, the changes in its expression in patients with epilepsy with comorbid depression remain unclear. In the present study, we analyzed depressive symptoms using neuropsychiatric scales in forty-two patients with drug-resistant TLE, who also underwent EEG in waking and sleeping states, as well as 3.0 T brain MRI. We tested for TREK-1 positive neurons and microglial cells in the anterior hippocampi of patients with drug-resistant TLE with and without comorbid depression (n=5/group). Approximately 31% of patients with TLE had comorbid depression (13/42). Meanwhile, the patients who had hippocampal sclerosis had much higher scores on the depression rating scale. The results indicated the contribution of hippocampal sclerosis to the development of depression. Immunostaining of TREK-1 channels was observed in neurons and glia in the anterior hippocampus. Increased immunoreactivity of TREK-1 neurons was observed in the hippocampi of patients with TLE with comorbid depression compared with nondepressed patients with TLE. TREK-1 was expressed in almost all microglia. Curiously, more activated TREK-1-positive microglia were observed in patients with TLE with depression than in those without depression. The results suggested that a change in TREK-1 immunoreactivity was involved, at least partly, in the development of depression as a comorbidity of TLE. Imbalance of the TREK-1 channel may be a potential target for the treatment of patients with epilepsy with comorbid depression.
Collapse
Affiliation(s)
- Xiao-Li Li
- Department of Neurology, Affiliated ZhongDa Hospital, Southeast University, Nanjing, China; Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chong-Yang Tang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Shu Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Meng Zhao
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiong-Fei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tian-Fu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Epilepsy, Beijing, China; Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Xue-Ling Qi
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guo-Ming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Epilepsy, Beijing, China; Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
| | - Yu-Guang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Epilepsy, Beijing, China; Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
| |
Collapse
|
65
|
Soncin LD, McGonigal A, Kotwas I, Belquaid S, Giusiano B, Faure S, Bartolomei F. Post-traumatic stress disorder (PTSD) in patients with epilepsy. Epilepsy Behav 2021; 121:108083. [PMID: 34091128 DOI: 10.1016/j.yebeh.2021.108083] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/15/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
Anxiety and depression in epilepsy are strongly documented but post-traumatic stress disorder (PTSD) is underestimated and poorly known. We studied the links between psycho-traumagenic events (TE), onset of epilepsy, and severity of PTSD symptoms in patients with epilepsy. The study included 54 patients with epilepsy and 61 controls. We used validated questionnaires to screen for anxiety, depression, and PTSD symptoms and we conducted an interview to measure the prevalence of TE. We developed an original exploratory questionnaire to assess the presence of PTSD during interictal and peri-ictal periods. The results show that patients reported more exposure to a TE and presented significantly more severe PTSD symptoms than controls. Seventy-eight percent of patients (vs. 52% of controls) had been exposed to a TE, and 26% (vs. 7%) had a score above the diagnostic threshold of the PTSD scale. In addition, 18.6% of patients reported that their epilepsy began at the same time as they began to experience PTSD symptoms following a TE. Patients with high PTSD scores (above the threshold, n = 14) reported significantly more depression symptoms than patients without PTSD and reported PTSD symptoms both during the ictal and peri-ictal periods. Within the whole group of patients, anxiety (72%) and depression (33%) symptoms significantly correlated with PTSD symptoms reported by the scale. This study shows that patients with epilepsy have increased prevalence of self-reported PTSD symptoms. We describe the clinical picture specific to patients with epilepsy, which may include classical PTSD symptoms but also specific peri-ictal symptoms.
Collapse
Affiliation(s)
- Lisa-Dounia Soncin
- Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales, Université Côte d'Azur, 28 Avenue de Valrose, 06103 Nice, France; Institut de Neurosciences des Systèmes, INSERM, Aix-Marseille Université Marseille, 58 bd Charles Livon, 13284 Marseille, France
| | - Aileen McGonigal
- Institut de Neurosciences des Systèmes, INSERM, Aix-Marseille Université Marseille, 58 bd Charles Livon, 13284 Marseille, France; Service d'Epileptologie et Rythmologie Cérébrale, Assistance Publique Hôpitaux de Marseille, 264 Rue Saint-Pierre, 13005 Marseille, France.
| | - Iliana Kotwas
- Service d'Epileptologie et Rythmologie Cérébrale, Assistance Publique Hôpitaux de Marseille, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - Sara Belquaid
- Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales, Université Côte d'Azur, 28 Avenue de Valrose, 06103 Nice, France; Service de Psychiatrie générale, Centre Hospitalier Universitaire de Nice, 30 Voie Romaine, 06000 Nice, France
| | - Bernard Giusiano
- Institut de Neurosciences des Systèmes, INSERM, Aix-Marseille Université Marseille, 58 bd Charles Livon, 13284 Marseille, France; Pôle de Santé Publique, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, 264 Rue Saint-Pierre, 13005 Marseille, France.
| | - Sylvane Faure
- Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales, Université Côte d'Azur, 28 Avenue de Valrose, 06103 Nice, France.
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, INSERM, Aix-Marseille Université Marseille, 58 bd Charles Livon, 13284 Marseille, France; Service d'Epileptologie et Rythmologie Cérébrale, Assistance Publique Hôpitaux de Marseille, 264 Rue Saint-Pierre, 13005 Marseille, France.
| |
Collapse
|
66
|
Batchelor R, Taylor MD. Young adults with epilepsy: Relationships between psychosocial variables and anxiety, depression, and suicidality. Epilepsy Behav 2021; 118:107911. [PMID: 33773441 DOI: 10.1016/j.yebeh.2021.107911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND People with epilepsy (PWE) are at an increased risk of anxiety, depression, and suicidality. Young adulthood is a critical developmental period which can be complicated by the unique challenges of having epilepsy. The risk factors of mental health difficulties in young adults with epilepsy (YAWE) have not been investigated. AIMS To examine the relationships between psychosocial variables (coping strategies and sources of social support) and mental health outcomes in YAWE, and determine whether these psychosocial variables independently predict mental health outcomes after controlling for sociodemographic and epilepsy-related factors. METHOD An online survey was completed by 144 YAWE (18-25-year-olds), which measured sociodemographic and epilepsy-related factors, coping strategies, sources of social support, and current mental health symptoms (anxiety, depression, and suicidality). RESULTS Avoidant-focused coping was positively correlated, and problem-focused coping and meaning-focused coping were negatively correlated, with symptoms of anxiety, depression, and suicidality. Social support from family, friends, and a special person all negatively correlated with mental health outcomes. Using multiple regression analyses, greater use of avoidant-focused coping strategies independently predicted higher symptoms of anxiety, depression, and suicidality. Greater support from friends independently predicted significantly lower anxiety and depression, whereas greater support from family independently predicted significantly lower suicidality. CLINICAL IMPLICATIONS These findings have implications for clinical practice in YAWE and suggest that screening for mental health symptoms and psychosocial variables to identify those at risk would be beneficial. Access to tailored psychological support is also needed.
Collapse
Affiliation(s)
| | - Michelle D Taylor
- Royal Holloway, University of London, Surrey, UK; Health Psychology Research Limited (HPR Ltd.), 188 Egham High Street, Surrey, UK
| |
Collapse
|
67
|
Lu Y, Zhong R, Li M, Zhao Q, Zhang X, Hu B, Lin W. Social anxiety is associated with poor quality of life in adults with epilepsy in Northeast China: A cross-sectional study. Epilepsy Behav 2021; 117:107866. [PMID: 33684784 DOI: 10.1016/j.yebeh.2021.107866] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to investigate the factors influencing the level of social anxiety in patients with epilepsy (PWE) in Northeast China. We also identified the effect of social anxiety on the quality of life in these patients. METHODS A consecutive cohort of 148 adult PWE from The First Hospital of Jilin University were recruited. In this sample, 116 patients had focal epilepsy, 20 had generalized epilepsy, and 12 had unclassified epilepsy. Depressive symptoms, social anxiety, and quality of life were evaluated using the Chinese version of the Patient Health Questionnaire 9 (PHQ-9), 20-item Social Phobia Scale (SPS), 20-item Social Interaction Anxiety Scale (SIAS), and Quality-of-Life Inventory in Epilepsy-31 (QOLIE-31), respectively. Multivariate linear regression analyses were employed to identify independent factors influencing SPS scores and SIAS scores. RESULTS Correlation analysis suggested that sex, age at onset, seizure frequency over the last year, AED treatment model, >50% nocturnal seizures, PHQ-9 score, and QOLIE-31 score had a significant correlation with the SPS score. The age at onset, seizure frequency over the last year, AED treatment model, PHQ-9 score, and QOLIE-31 score correlated with the SIAS score. Multiple linear regression analysis showed that the total QOLIE-31 score (β = - 0.481; p = 0.001) was inversely associated with the SPS score in PWE. Additionally, earlier age of onset (β = -0.156; p = 0.022) and low total QOLIE-31 score (β = -0.457; p = 0.001) were risk factors for high SIAS scores. CONCLUSION We found that social anxiety was independently associated with poor quality of life. Earlier age of onset was also a risk factor for social anxiety. Future studies with large sample sizes are required to confirm our findings.
Collapse
Affiliation(s)
- Yingxue Lu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Mengmeng Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qian Zhao
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Boqi Hu
- Radiology Department, China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
68
|
Radaelli G, Majolo F, Leal-Conceição E, de Souza Santos F, Escobar V, Zanirati GG, Portuguez MW, Scorza FA, da Costa JC. Left Hemisphere Lateralization of Epileptic Focus Can Be More Frequent in Temporal Lobe Epilepsy Surgical Patients with No Consensus Associated with Depression Lateralization. Dev Neurosci 2021; 43:1-8. [PMID: 33789300 DOI: 10.1159/000513537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is considered to be the most common form of epilepsy, and it has been seen that most patients are refractory to antiepileptic drugs. A strong association of this ailment has been established with psychiatric comorbidities, primarily mood and anxiety disorders. The side of epileptogenic may contribute to depressive and anxiety symptoms; thus, in this study, we performed a systematic review to evaluate the prevalence of depression in TLE in surgical patients. The literature search was performed using PubMed/Medline, Web of Science, and PsycNet to gather data from inception until January 2019. The search strategy was related to TLE, depressive disorder, and anxiety. After reading full texts, 14 articles meeting the inclusion criteria were screened. The main method utilized for psychiatric diagnosis was Diagnostic and Statistical Manual of Mental Disorders/Structured Clinical Interview for DSM. However, most studies failed to perform the neuropsychological evaluation. For those with lateralization of epilepsy, focus mostly occurred in the left hemisphere. For individual depressive diagnosis, 9 studies were evaluated, and 5 for anxiety. Therefore, from the data analyzed in both situations, no diagnosis was representative in preoperative and postoperative cases. In order to estimate the efficacy of surgery in the psychiatry episodes and its relation to seizure control, the risk of depression and anxiety symptoms in epileptic patients need to be determined before surgical procedures. Rigorous preoperative and postoperative evaluation is essential for psychiatry conditions in patients with refractory epilepsy candidates for surgery.
Collapse
Affiliation(s)
- Graciane Radaelli
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Majolo
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Post-graduate Program in Biotechnology, Universidade do Vale do Taquari - Univates, Lajeado, Brazil
| | - Eduardo Leal-Conceição
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Francisco de Souza Santos
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Vinícius Escobar
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriele Goulart Zanirati
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mirna Wetters Portuguez
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fulvio Alexandre Scorza
- Department of Neurology and Neurosurgery, Laboratory of Neuroscience, Federal University of São Paulo, São Paulo, Brazil.,Researcher from CNPq, Porto Alegre, Brazil
| | - Jaderson Costa da Costa
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Researcher from CNPq, Porto Alegre, Brazil
| |
Collapse
|
69
|
Dang YL, Foster E, Lloyd M, Rayner G, Rychkova M, Ali R, Carney PW, Velakoulis D, Winton-Brown TT, Kalincik T, Perucca P, O'Brien TJ, Kwan P, Malpas CB. Adverse events related to antiepileptic drugs. Epilepsy Behav 2021; 115:107657. [PMID: 33360400 DOI: 10.1016/j.yebeh.2020.107657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/04/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Adverse events (AEs) related to antiepileptic drugs (AEDs) may interfere with adequate dosing and patient adherence, leading to suboptimal seizure control, and relatedly, increased injuries, hospitalizations, and mortality. This study investigated the clinicodemographic factors associated with AEs related to AEDs as reported by the Liverpool Adverse Events Profile (LAEP), and explored the ability of LAEP to discriminate between epilepsy and psychogenic nonepileptic seizures (PNES). We hypothesized that female sex, mood disorders, AED-polytherapy, duration, and severity of epilepsy are associated with increased endorsement of AEs related to AEDs, and that endorsement of AEs related to AEDs would significantly differ between epilepsy and PNES patients. METHODS We prospectively enrolled adult patients admitted to two inpatient video-electroencephalogram monitoring units. Clinicodemographic variables and psychometric measures of depression, anxiety, and cognitive function were recorded. Patient-reported AE endorsement was obtained using the LAEP, which was reduced to four latent domains using exploratory structural equation modeling. General linear models identified variables associated with each domain. Logistic regression determined the ability of LAEP scores to differentiate between epilepsy and PNES. RESULTS 311 patients met inclusion criteria. Mean age was 38 years and 56% of patients were female. Network analysis demonstrated strong relationships between depression and anxiety with physical, sleep, psychiatric, and dermatological AE endorsement. Depression, female sex, and AED polytherapy were associated with greater AE endorsement. Epilepsy, compared to PNES, was associated with lower AE endorsement. Fewer prescribed AEDs and greater reported physical AE endorsement were associated with PNES diagnosis. SIGNIFICANCE There is a strong relationship between patient-reported AEs and psychiatric symptomatology. Those with PNES paradoxically endorse greater physical AEs despite receiving fewer AEDs. Patients who endorse AEs in clinical practice should be screened for comorbid depression or anxiety and treated accordingly.
Collapse
Affiliation(s)
- Yew Li Dang
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
| | - Emma Foster
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
| | - Michael Lloyd
- Department of Psychiatry, Alfred Health, Melbourne, Australia
| | - Genevieve Rayner
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Maria Rychkova
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Rashida Ali
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Patrick W Carney
- Department of Medicine, Monash University and Eastern Health, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia
| | | | - Tomas Kalincik
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH), The University of Melbourne, Parkville, Australia
| | - Piero Perucca
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Terence J O'Brien
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Patrick Kwan
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Charles B Malpas
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH), The University of Melbourne, Parkville, Australia
| |
Collapse
|
70
|
Christian CA, Reddy DS, Maguire J, Forcelli PA. Sex Differences in the Epilepsies and Associated Comorbidities: Implications for Use and Development of Pharmacotherapies. Pharmacol Rev 2021; 72:767-800. [PMID: 32817274 DOI: 10.1124/pr.119.017392] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The epilepsies are common neurologic disorders characterized by spontaneous recurrent seizures. Boys, girls, men, and women of all ages are affected by epilepsy and, in many cases, by associated comorbidities as well. The primary courses of treatment are pharmacological, dietary, and/or surgical, depending on several factors, including the areas of the brain affected and the severity of the epilepsy. There is a growing appreciation that sex differences in underlying brain function and in the neurobiology of epilepsy are important factors that should be accounted for in the design and development of new therapies. In this review, we discuss the current knowledge on sex differences in epilepsy and associated comorbidities, with emphasis on those aspects most informative for the development of new pharmacotherapies. Particular focus is placed on sex differences in the prevalence and presentation of various focal and generalized epilepsies; psychiatric, cognitive, and physiologic comorbidities; catamenial epilepsy in women; sex differences in brain development; the neural actions of sex and stress hormones and their metabolites; and cellular mechanisms, including brain-derived neurotrophic factor signaling and neuronal-glial interactions. Further attention placed on potential sex differences in epilepsies, comorbidities, and drug effects will enhance therapeutic options and efficacy for all patients with epilepsy. SIGNIFICANCE STATEMENT: Epilepsy is a common neurological disorder that often presents together with various comorbidities. The features of epilepsy and seizure activity as well as comorbid afflictions can vary between men and women. In this review, we discuss sex differences in types of epilepsies, associated comorbidities, pathophysiological mechanisms, and antiepileptic drug efficacy in both clinical patient populations and preclinical animal models.
Collapse
Affiliation(s)
- Catherine A Christian
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Doodipala Samba Reddy
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Jamie Maguire
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Patrick A Forcelli
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| |
Collapse
|
71
|
Tombini M, Assenza G, Quintiliani L, Ricci L, Lanzone J, Di Lazzaro V. Epilepsy and quality of life: what does really matter? Neurol Sci 2021; 42:3757-3765. [PMID: 33449244 DOI: 10.1007/s10072-020-04990-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/11/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess quality of life (QoL) in adult people with epilepsy (PWE) and identify the main factors affecting it. METHODS We enrolled consecutively 122 PWE. They were interviewed for a careful collection of demographic and clinical data. Patients completed dedicated questionnaires for the assessment of the quality of life (Quality of Life in Epilepsy Scale-31) (Q31) as well as psychosocial features: depressive symptoms (DS) (Beck Depression Inventory-II/BDI-II), difficulties of emotion regulation (Difficulties of Emotion Regulation Scale/DERS), and stigma related to epilepsy (Stigma Scale of Epilepsy/SSE and Jacoby's Stigma Scale/JSS). The results of Q31 and their subscales were correlated with clinical details of PWE, as well as the other scores. A stepwise multiple regression analysis was applied to identify the main factors affecting QoL. RESULTS Quality of life is inversely correlated mostly with psychosocial features, as DS, emotion dysregulation, and stigma perception, as well as with epilepsy-related factors, as the seizure frequency and number of antiseizure medications (ASMs). The combination of DS, perceived stigma, and number of ASMs best explained the QoL. Worse features of QoL were detected in females and in patients with age of epilepsy onset in adulthood. CONCLUSION Quality of life in adult PWE is predominantly affected by psychosocial factors more than epilepsy-related ones. These findings suggest that effective epilepsy management requires more than seizure control, and early detection of psychological dysfunction and tailored interventions to improve the QoL should be considered.
Collapse
Affiliation(s)
- Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy.
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Livia Quintiliani
- Psicologia Clinica, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| |
Collapse
|
72
|
Zhong R, Chen Q, Li M, Li N, Chu C, Li J, Zhang X, Lin W. A cross-sectional study on the association of serum uric acid levels with depressive and anxiety symptoms in people with epilepsy. BMC Psychiatry 2021; 21:17. [PMID: 33413258 PMCID: PMC7791969 DOI: 10.1186/s12888-020-03019-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND High serum uric acid (SUA) levels may provide protection against depression and anxiety through its defensive role in oxidative damage. The aim of this study was to test the hypothesis of the independent associations of lower SUA levels with depressive and anxiety symptoms among patients with epilepsy (PWE). METHODS A cross-sectional study was performed among 320 PWE aged ≥18 years old in Northeast China. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E; Chinese version) and the Generalized Anxiety Disorder-7 scale (GAD-7; Chinese version) were used as screening tools for depressive and anxiety symptoms for PWE. Serum uric acid levels were measured. The associations of SUA levels with depressive and anxiety symptoms were assessed by using binary logistic regression models, with adjustment for the related risk factors (P< 0.05). RESULTS Lower SUA tertiles were significantly associated with higher C-NDDI-E and GAD-7 scores compared with the higher two tertiles (p=0.001, and p= 0.002). Patients with depressive symptoms exhibited significantly lower SUA levels compared to those without depressive symptoms (p< 0.001). SUA levels of patients with anxiety symptoms were significantly lower than those of patients without anxiety symptoms (p< 0.001). The first and second SUA tertiles were associated with depressive symptoms, with the third tertile group as the reference group, after adjusting for confounders (first tertile: OR = 4.694, 95% CI = 1.643~ 13.413, P = 0.004; second tertile: OR = 3.440, 95% CI = 1.278~9.256, P = 0.014). However, The first and second SUA tertiles were not associated with the risk of anxiety symptoms compared with the third tertile in the adjusted logistic regression model (First tertile: OR = 1.556, 95% CI = 0.699~3.464, P = 0.279; second tertile: OR = 1.265, 95% CI = 0.607~2.635, P = 0.530). CONCLUSION We found that lower SUA levels were independently associated with depressive symptoms but not with anxiety symptoms among PWE. Further well-designed prospective cohort studies are required to determine the causality of the associations and to further clarify the mechanisms of SUA in depressive symptoms.
Collapse
Affiliation(s)
- Rui Zhong
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Qingling Chen
- grid.265021.20000 0000 9792 1228Department of Hepatology, Tianjin Medical University, Tianjin Second People’s Hospital, Tianjin, China
| | - Mengmeng Li
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Nan Li
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Chaojia Chu
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Jing Li
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Xinyue Zhang
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, China.
| |
Collapse
|
73
|
Lagogianni C, Gatzonis S, Patrikelis P. Fatigue and cognitive functions in epilepsy: A review of the literature. Epilepsy Behav 2021; 114:107541. [PMID: 33243688 DOI: 10.1016/j.yebeh.2020.107541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
Epilepsy is a common neurological disorder affecting people of all ages and inducing cognitive impairments. While research has advanced in terms of neuropsychological enquiries of the various epileptic syndromes, the understanding of more complex and ill-defined phenomena such as fatigue is still unclear for epilepsy. It is suggested that fatigue is not just physical, but there can also be a cognitive element to it. Although studies in other conditions have been able to identify a relationship between fatigue and particular cognitive components, similar evidence is sparse in patients with epilepsy. This review is an attempt to gather, analyze, integrate, and critically discuss available information on fatigue and its rapport with various aspects of epilepsy, particularly focusing on cognition. Future directions are discussed urging researchers to target cognitive components of fatigue.
Collapse
Affiliation(s)
- Christodouli Lagogianni
- Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece; ICPS College for Humanistic Sciences, Athens, Greece.
| | - Stylianos Gatzonis
- Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece
| | - Panayiotis Patrikelis
- Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece
| |
Collapse
|
74
|
Sylla M, Vogel AC, Bah AK, Tassiou NR, Barry SD, Djibo BA, Toure ML, Foksona S, Konate M, Cisse FA, Mateen FJ. Prevalence, severity, and associations of depression in people with epilepsy in Guinea: A single-center study. Epilepsy Behav 2020; 113:107475. [PMID: 33189054 PMCID: PMC7736546 DOI: 10.1016/j.yebeh.2020.107475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/10/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Depression has long been recognized as a comorbidity of epilepsy in high-income countries, ranging from 17 to 49% of people with epilepsy (PWE). Of the limited studies from sub-Saharan Africa (SSA), where most people have uncontrolled seizures, an even higher prevalence of depression is reported among PWE at times exceeding 80%. We sought to assess the prevalence and severity of depression and its associated factors among PWE in Guinea, a sub-Saharan West African country where most PWE have poorly controlled seizures. METHODS People with epilepsy from the community, age 16 years old and above, were consecutively recruited into a convenience cohort at the Ignace Deen Hospital in the capital city, Conakry, in summer 2018 as part of a larger study characterizing PWE in Guinea. Each participant was evaluated by a team of Guinean physicians and a U.S.-based neurologist to confirm the diagnosis of epilepsy. Inperson interviews were performed to measure demographic, clinical, socioeconomic, and related variables. Depression was measured via the Patient Health Questionniare-9 in the language of the participant's preference with a cutoff of 5 or more points being categorized as depressed. Regression analyses were performed to measure the associations between explanatory variables with the outcome of depression. RESULT Of 140 PWE (age range: 16-66 years old; 64 female; 64% taking an antiseizure medication including 28% carbamazepine, 16% phenobarbital, and 14% valproic acid; duration of epilepsy: 11 years; 71% with one or more seizures in the past month; 17% never treated with an antiseizure medication; 90% with loss of consciousness during seizures; 10% without formal education; 31% with university level education; 62% using tap water; 48% with a serious seizure-related injury), the point prevalence of depression was 66% (95% confidence interval [CI]: 58%-74%): 43% of PWE had mild depression, 19% moderate, 4% moderate to severe, and 0.1% severe. In a multivariate analysis, the occurrence of a seizure in the past month (odds ratio: 3.03, 95% CI: 2.63-3.48, p = 0.01) was associated with depression, while gender, self-perceived stigma score, serious injuries, and the number of antiseizure medications taken were not statistically significantly associated (p > 0.05). Twenty-five percent of all participants endorsed thoughts of self-harm or suicidality. CONCLUSION Two-thirds of PWE in Guinea had depression in this single-institution convenience cohort. The presence of a seizure in the last month was the factor most associated with depression and is modifiable in many PWE. The high prevalance of depression suggests that screening and addressing depressive symptoms should be incorporated into routine epilepsy care in Guinea.
Collapse
Affiliation(s)
| | - Andre C. Vogel
- Department of Neurology, Massachusetts General Hospital, Boston, USA
| | | | | | | | | | | | | | | | | | - Farrah J. Mateen
- Harvard Medical School, Boston, USA,Department of Neurology, Massachusetts General Hospital, Boston, USA
| |
Collapse
|
75
|
Spatially expandable fiber-based probes as a multifunctional deep brain interface. Nat Commun 2020; 11:6115. [PMID: 33257708 PMCID: PMC7704647 DOI: 10.1038/s41467-020-19946-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/29/2020] [Indexed: 11/28/2022] Open
Abstract
Understanding the cytoarchitecture and wiring of the brain requires improved methods to record and stimulate large groups of neurons with cellular specificity. This requires miniaturized neural interfaces that integrate into brain tissue without altering its properties. Existing neural interface technologies have been shown to provide high-resolution electrophysiological recording with high signal-to-noise ratio. However, with single implantation, the physical properties of these devices limit their access to one, small brain region. To overcome this limitation, we developed a platform that provides three-dimensional coverage of brain tissue through multisite multifunctional fiber-based neural probes guided in a helical scaffold. Chronic recordings from the spatially expandable fiber probes demonstrate the ability of these fiber probes capturing brain activities with a single-unit resolution for long observation times. Furthermore, using Thy1-ChR2-YFP mice we demonstrate the application of our probes in simultaneous recording and optical/chemical modulation of brain activities across distant regions. Similarly, varying electrographic brain activities from different brain regions were detected by our customizable probes in a mouse model of epilepsy, suggesting the potential of using these probes for the investigation of brain disorders such as epilepsy. Ultimately, this technique enables three-dimensional manipulation and mapping of brain activities across distant regions in the deep brain with minimal tissue damage, which can bring new insights for deciphering complex brain functions and dynamics in the near future. Existing neural interfaces are limited in accessing one, small brain region. Here, the authors introduce a scaffold with helix hollow channels, which direct multisite multifunctional fibre probes into the brain at different angles, allowing for simultaneous recording and stimulation across distant regions.
Collapse
|
76
|
Avalos JC, Silva BA, Tevés Echazu MF, Rosso B, Besocke AG, Del Carmen Garcia M. Quality of life in patients with epilepsy or psychogenic nonepileptic seizures and the contribution of psychiatric comorbidities. Epilepsy Behav 2020; 112:107447. [PMID: 32947249 DOI: 10.1016/j.yebeh.2020.107447] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 11/29/2022]
Abstract
UNLABELLED Epilepsy is a common neurological disorder, and psychogenic nonepileptic seizures (PNES) is an important differential diagnosis. Psychiatric comorbidities are prevalent among people with epilepsy (PWE). Additionally, lower quality of life (QoL) in people with PNES compared with PWE was reported with higher rates of general psychiatric comorbidity. Although there are previous studies evaluating the QoL in patients with epilepsy, this study is unique and compelling because it represents a study comparing PNES and PWE on QoL, depression, and anxiety in a Spanish-speaking group of Argentine patients. The aim of this study was to analyze self-reported anxiety and depression in PWE and PNES and to establish the impact on QoL. METHODS This is a cross-sectional study; QoL was measured using the Quality of Life in Epilepsy Inventory (QOLIE-31). To study anxiety and depression, the Hospital Anxiety and Depression Scale (HADS) was administered. Clinical and complementary data were recorded. RESULTS Psychogenic nonepileptic seizures scored significantly higher in anxiety and depression and with lower levels of QoL compared with PWE. Anxiety and depression had a negative correlation with QoL. CONCLUSION Nonepileptic seizures have an even greater impact on QoL than epileptic seizures, and this could be influenced by psychiatric comorbidities. These findings corroborate what other studies in English-speaking nations that have found regarding the impact of psychopathology on QoL in those with PNES and further support the importance of assessing for psychiatric comorbidities to tailor treatment.
Collapse
Affiliation(s)
- Juan Carlos Avalos
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | | | - Maria F Tevés Echazu
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | - Bárbara Rosso
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | - Ana Gabriela Besocke
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | | |
Collapse
|
77
|
Benevides RDDL, de-Lima SMV, Chagas CL, de Lima CF, Abadie-Guedes R, Guedes RCA. Lactation in large litters influences anxiety, memory, and spreading depression in adult male rats that were chronically subjected to a non-convulsive pilocarpine dose. Nutr Neurosci 2020; 25:846-856. [PMID: 32912080 DOI: 10.1080/1028415x.2020.1819103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: Unfavorable lactation influences brain excitability and behavioral reactions in adults. Administration early in life of the cholinergic agonist, pilocarpine, even at non-convulsive doses, alters the brain excitability-related phenomenon known as cortical spreading depression (CSD), and produce anxiogenic-like behavior. However, the influence of unfavorable lactation on the CSD- and memory-effects of pilocarpine administration late in life has not been investigated. Herein, we analyzed the ponderal, electrophysiological (CSD), and behavioral effects of chronic treatment with a non-convulsive dose of pilocarpine, in adult rats suckled under favorable and unfavorable conditions.Methods: Wistar rats were suckled in litters with 9 or 15 pups (groups L9 and L15, respectively). A very low dose of pilocarpine (45/mg/kg/day) was chronically administered in mature rats from postnatal day (PND) 69-90. Behavioral tests occurred at PND91 [elevated plus maze (EPM)], PND93 [open field (OF)], and PND94-95 [object recognition memory (ORM)]. CSD was recorded between PND96-120.Results: Pilocarpine-treated rats performed worse in the anxiety and memory tests, and displayed lower CSD propagation velocity when compared with saline-treated controls. In addition, L15 rats showed an increase in the distance traveled and a decrease in the immobility time in the EPM, impaired ORM, and accelerated CSD propagation when compared with L9 rats (p ≤ 0.05).Discussion: These data suggest that sub-convulsive pilocarpine treatment in adult rats can affect behavioral and excitability-related reactions. In addition, unfavorable lactation increases the ambulatory effects of pilocarpine. Further studies should investigate the possible cholinergic molecular mechanisms involved in these effects.
Collapse
Affiliation(s)
| | | | - Camila Lima Chagas
- Department of Nutrition, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Clara Farah de Lima
- Department of Nutrition, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Ricardo Abadie-Guedes
- Department of Physiology and Pharmacology, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | |
Collapse
|
78
|
Shamsalinia A, Moradi M, Farahani MA, Masoudi R, Ghadimi R, Rad RE, Ghaletaki GZ, Ghaffari F. Designing and psychometric evaluation of disease-related fear scale (D-RFS) in adults with epilepsy: A sequential exploratory mixed methods design. Epilepsy Behav 2020; 110:107169. [PMID: 32504981 DOI: 10.1016/j.yebeh.2020.107169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Disease-related fear is one of the important diagnoses of healthcare providers in caring for people with epilepsy whose conceptual dimensions should be discovered and investigated. To this end, it is necessary to provide healthcare providers with appropriate tools to assess fears related to the disease in accordance with the sociocultural milieu of each community. AIM The purpose of this study was to design and psychometrically evaluate the disease-related fear scale (D-RFS) in adults with epilepsy. METHODS This study was of a sequential exploratory mixed methods design conducted in Iran in 2019. In the item generation phase, inductive (face-to-face, semi-structured interviews with 14 adult patients with epilepsy) and deductive (literature review) were used. In the item reduction, integration of qualitative and literature reviews and scale evaluation were performed. For the scale evaluation, face validity, content validity, construct validity [exploratory factor analysis (EFA) (n = 367) and confirmatory factor analysis (CFA) (n = 250)], and convergent and divergent validity and reliability (internal consistency and stability) were investigated. RESULTS After the qualitative phase and literature review, 40 items were codified. After investigation of the qualitative and quantitative face validity, 7 items were deleted. Two items were deleted due to content validity ratio (CVR) of less than 0.56 and one item due to content validity index (CVI) of less than 0.78. Finally, a 30-item scale was obtained, and its construct validity was assessed. Kaiser-Meyer-Olkin (KMO) index was 0.85, and Bartlett's test of sphericity was 7237.504, P < 0. 001. The results of CFA showed that the bivariate model of the D-RFS (fear of seizure consequences and fear of the disease's long-term consequences) had the most appropriate fitness to the data. Convergent and divergent validity results showed that the values of composite reliability (CR) and average variance extracted (AVE) for the two factors were greater than 0.7 and 0.5, respectively, and the AVE for each factor was greater than CR. Internal consistency of the first and second factors were obtained 0.891 and 0.910, respectively. Cronbach's alpha coefficient for the total scale was obtained 0.921. The results of test-retest reliability showed that there was a significant agreement between the scores of the test and retest (P < .001). CONCLUSION The D-RFS has an acceptable factorial structure, and its internal consistency was confirmed by different approaches. This scale is a valid and reliable tool for assessing disease-related fear in patients with epilepsy. The simplicity of the items and the appropriate time to complete the scale can be considered as its strengths.
Collapse
Affiliation(s)
- Abbas Shamsalinia
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Mansoureh Ashghali Farahani
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Masoudi
- Community-Oriented Nursing Midwifery Research Center, Department of Adult and Geriatric Nursing, Nursing and Midwifery School, Shahr-e-Kord University of Medical Sciences, Shahr-e-Kord, Iran
| | - Reza Ghadimi
- Social Determinants of Health Research center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Reza Ebrahimi Rad
- Department of Medicine, Islamic Azad University, Tonekabon Branch, Tonekabon, Mazandaran, Iran
| | - Gholamreza Zamani Ghaletaki
- Pediatrics Psychiatry, Tehran University of Medical Sciences, Iranian Epilepsy Association Board, Tehran, I.R., Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| |
Collapse
|
79
|
de Oliveira DD, da Silva CP, Iglesias BB, Beleboni RO. Vitexin Possesses Anticonvulsant and Anxiolytic-Like Effects in Murine Animal Models. Front Pharmacol 2020; 11:1181. [PMID: 32848784 PMCID: PMC7431698 DOI: 10.3389/fphar.2020.01181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/20/2020] [Indexed: 12/19/2022] Open
Abstract
Different types of epilepsy and forms of pathological anxiety have been described as significant neurological disorders that may exist as comorbidities. Some of those disorders share the association of affected limbic areas/neuropathological triggers as well as the use of drugs for their clinical management. The aim of this work was to investigate the anticonvulsant and anxiolytic properties of the vitexin (apigenin-8-C-glucoside), since this compound is a flavonoid usually found as one of the major constituents in several medicinal plants claimed as anxiolytics and/or anticonvulsants. This investigation was performed by the use of a series of classical murine animal models of chemically induced-seizures and of anxiety-related tests (open-field, elevated plus-maze, and light-dark box tests). Here, we show that the systemic administration of vitexin (1.25; 2.5 and 5 mg/kg; i.p.) exhibited selective protection against chemically-induced seizures. Vitexin did not block seizures evoked by glutamate receptors agonists (NMDA and kainic acid), and it did not interfere with the latencies for these seizures. Conversely, the same treatments protected the animals in a dose-dependent manner against the seizures evoked by the Gabaergic antagonists picrotoxin and PTZ and rise the latency time for the first seizure on non-protected animals. The higher dose of vitexin protected 100% of animals against the tonic-clonic seizures triggered by GABA antagonists. The results from open-field, elevated plus-maze, and light-dark box tests indicated the anxiolytic properties of vitexin at similar range of doses described for the anticonvulsant action screening. Furthermore, these results pointed that vitexin did not cause sedation or locomotor impairment on animals. The selective action of vitexin against picrotoxin and PTZ may reinforce the hypothesis by which this compound acts mainly by the modulation of GABAergic neurotransmission and/or related pathways. This could be useful to explain the dual activity of vitexin as anticonvulsant and anxiolytic, and highlight the pharmacological interest on this promising flavonoid.
Collapse
Affiliation(s)
| | | | | | - Renê O. Beleboni
- Department of Biotechnology, University of Ribeirão Preto, Ribeirão Preto, Brazil
- School of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil
| |
Collapse
|
80
|
Tao Z, Chun-Yan H, Hua P, Bin-Bin Y, Xiaoping T. Phyllathin From Phyllanthus Amarus Ameliorates Epileptic Convulsion and Kindling Associated Post-Ictal Depression in Mice via Inhibition of NF-κB/TLR-4 Pathway. Dose Response 2020; 18:1559325820946914. [PMID: 32821254 PMCID: PMC7412921 DOI: 10.1177/1559325820946914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/14/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Epilepsy is a chronic, complex, unprovoked, and recurrent disorder of the nervous system that affected several people worldwide. Phyllanthus amarus (PA) has been documented to have neuroprotective potential. Aim To evaluate the potential of standardized extract of PA and its possible mechanism of action against the Pentylenetetrazol (PTZ)-induced convulsion and kindling associated post-ictal depression in experimental mice. Materials and Methods Phyllathin was isolated from methanolic extract of PA and well-characterized using HPTLC, ESI-MS/MS, and LC/MS. Phyllathin containing a standardized extract of PA (50, 100, and 200 mg/kg) was administered in convulsed and kindled mice, followed by an assessment of various parameters. Results The spectral analysis confirmed the molecular formula and weight of phyllanthin as C24H34O6 and 418.2342 Da. PA (100 and 200 mg/kg) significantly ameliorated PTZ-induced (p < 0.05) duration, onset of tonic-clonic convulsion, and mortality in mice. It also significantly attenuated (p < 0.05) PTZ-induced kindling in mice. Alteration in brain GABA, dopamine, and glutamate, Na+K+ATPase, Ca+2-ATPase activities, and oxido-nitrosative stress in kindled mice was significantly restored (p < 0.05) by PA treatment. It also significantly (p < 0.05) down-regulated brain mRNA expressions of NF-κB, TNF-α, IL-1β, COX-2, and TLR-4. Histological aberrations induced by PTZ in the brain of a kindled rat was significantly (p < 0.05) ameliorated by PA. Conclusion Phyllanthin containing a standardized extract of PA exerts its antiepileptic potential via balancing excitatory (glutamate) and inhibitory (GABA) brain monoamines, voltage-gated ion channels (Na+K+/Ca+2-ATPase) and inhibition of NF-κB/TLR-4 pathway to ameliorate neuroinflammation (TNF-α, IL-1β, and COX-2) in experimental mice.
Collapse
Affiliation(s)
- Zhang Tao
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hu Chun-Yan
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Peng Hua
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yang Bin-Bin
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tang Xiaoping
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| |
Collapse
|
81
|
Teh KX, Henien NPB, Wong LS, Wong ZKH, Raja Ismail RZ, Achok HN, Mariapun J, Yunos NM. A cross-sectional study on the rate of non-adherence to anti-seizure medications and factors associated with non-adherence among patients with epilepsy. PLoS One 2020; 15:e0235674. [PMID: 32649723 PMCID: PMC7351198 DOI: 10.1371/journal.pone.0235674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Non-adherence to anti-seizure medication (ASM) therapy is an important contributing factor to the higher mortality rate and treatment failure of epilepsy. This study aimed to determine the rate and factors associated with non-adherence to ASM therapy through the WHO five dimensions of medication adherence framework. Methods We conducted a cross-sectional study at an outpatient Neurology Clinic of a tertiary government hospital in Malaysia. Between March and July 2019, we identified 217 patients with a confirmed diagnosis of epilepsy, receiving oral ASM therapy and able to administer their medications. We performed a semi-structured interview to gather information on sociodemographic background, clinical and medication history, and perceptions on healthcare services. Adherence to ASM therapy was evaluated using the Medication Compliance Questionnaire (MCQ). Patient’s illness perception was assessed by the Brief Illness Perception Questionnaire (B-IPQ). Results 208 patients participated in this study. The median age of the study participants was 35 years (IQR 26–44). 58.2% were females and majority, 55.8%, were from the Malay ethnic group. Based on the MCQ scoring, 89 patients (42.8%) were non-adherent. Multiple logistic regression demonstrated that being employed or students (adjusted odds ratio [aOR] 2.26, 95%CI: 1.19–4.29 p = 0.012) and having an average or below average perceived access to pharmacy services (aOR 2.94, 95%CI: 1.38–6.24, p = 0.005) were significant contributors to non-adherence. Conclusion Being employed or students and having an average or below average perceived access to pharmacy services were associated with ASM non-adherence Efforts to improve ASM adherence should adopt a comprehensive approach considering the success of adherence is contingent on the interrelationship of multiple dimensions.
Collapse
Affiliation(s)
- Kai Xuan Teh
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Nevein Philip Botross Henien
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
- * E-mail:
| | - Lyang Shenz Wong
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Zoe Kee Hui Wong
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Raja Zarina Raja Ismail
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Hamdi Najman Achok
- Department of Medicine, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Jeevitha Mariapun
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Nor’azim Mohd Yunos
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| |
Collapse
|
82
|
Ison R, Kisan V, Cole C, Angus-Leppan H. The Epilepsy Risk Awareness (ERA) Scale: A New Era for Holistic Risk Assessment in Epilepsy. Front Neurol 2020; 11:465. [PMID: 32595587 PMCID: PMC7300212 DOI: 10.3389/fneur.2020.00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Best care in epilepsy balances protecting people with epilepsy from risks and avoiding undue restrictions in order to improve quality of life. To date, no single risk assessment tool has been widely adopted by both people with epilepsy and health-care professionals such as specialist epilepsy nurses. The present research refined the Epilepsy Risk Awareness (ERA) Scale, a validated and holistic risk assessment tool, by assessing test-retest reliability of each question and incorporating suggestions from patients regarding design and content. Methods: The draft clinical scale was administered to 102 adult participants from the Epilepsy Service at the Royal Free London National Health Service (NHS) Foundation Trust on two occasions. Quantitative and qualitative analyses were conducted-intraclass correlation coefficient (ICC) estimates were used to assess test-retest reliability of questions, and thematic analysis was used to analyze participants' comments and feedback. Following analysis, the ERA Scale was amended. Of the 102 participants, 32 conducted a further review of the revised ERA Scale to test completion time and provide final comments. Results: ICC reliability level estimates varied from "poor to moderate" to "good to excellent," and four qualitative themes were identified. The ERA Scale was amended accordingly to enhance practicality and usefulness, reducing completion time to approximately 5 min. Significance: The ERA Scale is a validated tool that aims to change clinical practice by standardizing risk assessment in epilepsy, providing a holistic approach that focuses on improved safety and quality of life.
Collapse
Affiliation(s)
- Rachel Ison
- Clinical Neurosciences, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Virad Kisan
- University College London Medical School, London, United Kingdom
| | - Christine Cole
- Harrow Neurology Specialist Nursing Service, Middlesex, United Kingdom
| | - Heather Angus-Leppan
- Clinical Neurosciences, Royal Free London NHS Foundation Trust, London, United Kingdom.,UCL Queen Square Institute of Neurology, London, United Kingdom
| |
Collapse
|
83
|
Sebera F, Vissoci JRN, Umwiringirwa J, Teuwen DE, Boon PE, Dedeken P. Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda. PLoS One 2020; 15:e0234095. [PMID: 32530968 PMCID: PMC7292570 DOI: 10.1371/journal.pone.0234095] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with epilepsy (PwE) have an increased risk of active and lifetime depression. Two in 10 patients experience depression. Lack of trained psychiatric staff in low- and middle-income countries (LMIC) creates a need for screening tools that enable detection of depression in PwE. We describe the translation, validity and reliability assessment of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for depression among PwE in Rwanda. METHOD PHQ-9 was translated to Kinyarwanda using translation-back translation and validated by a discussion group. For validation, PwE of ≥15 years of age were administered the PHQ-9 and Hamilton Depression Rating Scale (HDRS) by trained psychiatry staff at Visit 1. A random sample of 20% repeated PHQ-9 and HDRS after 14 days to assess temporal stability and intra-rater reliability. Internal structure, reliability and external validity were assessed using confirmatory factor analysis, reliability coefficients and HDRS-correlation, respectively. Maximal Youden's index was considered for cut-offs. RESULTS Four hundred and thirty-four PwE, mean age 30.5 years (SD ±13.3), were included of whom 33.6%, 37.9%, 13.4%, and 15.1% had no, mild, moderate and severe depression, respectively. PHQ-9 performed well on a one-factor model (unidimensional model), with factor loadings of 0.63-0.86. Reliability coefficients above 0.80 indicated strong internal consistency. Good temporal stability was observed (0.79 [95% CI: 0.68-0.87]). A strong correlation (R = 0.66, p = 0.01) between PHQ-9 and HDRS summed scores demonstrated robust external validity. The optimal cut-off for the PHQ-9 was similar (≥5) for mild and moderate depression and ≥7 for severe depression. CONCLUSION PHQ-9 validation in Kinyarwanda creates the capacity to screen PwE in Rwanda at scores of ≥5 for mild or moderate and ≥7 for severe depression. The availability of validated tools for screening and diagnosis for depression is a forward step for holistic care in a resource-limited environment.
Collapse
Affiliation(s)
- Fidèle Sebera
- CARAES Neuropsychiatric Hospital, Ndera, Kigali, Rwanda
- Centre Hospitalier Universitaire Kigali (CHUK), Kigali, Rwanda
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University Medical School, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | | | | | - Peter Dedeken
- UCB Pharma, Brussels, Belgium
- Ghent University Hospital, Ghent, Belgium
- Heilig Hart Hospitaal, Lier, Belgium
- * E-mail:
| |
Collapse
|
84
|
Tombini M, Assenza G, Quintiliani L, Ricci L, Lanzone J, Ulivi M, Di Lazzaro V. Depressive symptoms and difficulties in emotion regulation in adult patients with epilepsy: Association with quality of life and stigma. Epilepsy Behav 2020; 107:107073. [PMID: 32320931 DOI: 10.1016/j.yebeh.2020.107073] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of the study was to assess depressive symptoms (DS) and difficulties in emotion regulation (ER) in adult people with epilepsy (PWE) and their correlation with quality of life and stigmatization feelings of patients. MATERIALS AND METHODS We enrolled consecutively 110 PWE who completed the Beck Depression Inventory-II (BDI-II) questionnaire and, for the first time, the Italian translation of Difficulties in Emotion Regulation Scale (DERS) to evaluate DS and ER. They also fulfilled the Italian version of the Stigma Scale of Epilepsy (SSE), which allowed the quantification of the stigma perception by our cohort of patients and a 3-item Jacoby's Stigma Scale (JSS) and QOLIE-31 (Q31) for the evaluation of stigma and the quality of life. The results of BDI-II and DERS were correlated with clinical details of PWE, as well as the Q31 and SSE scores. Finally, a multiple stepwise regression analysis was applied to identify the main factors affecting DS and ER difficulties in these patients. RESULTS About 30% of PWE evidenced DS, of which 17.3% showed a BDI-II score higher than 19, suggestive of moderate to severe DS. Several factors related to epilepsy (seizure frequency, number of antiepileptic drugs (AEDs)) as well as ER and quality of life/stigmatization perception resulted significantly correlated with DS. As a new finding, the main factors affecting DS in PWE turned out to be the difficulties in ER and quality of life and stigma perception (as evaluated through Q31 and JSS scores). CONCLUSIONS Our findings evidenced that DS in PWE are highly prevalent and strongly correlated with ER difficulties that mostly influence DS together with quality of life and stigma perception. Depressive symptoms and emotion dysregulation are linked by a bidirectional relationship and are significantly associated with worse quality of life and higher stigmatization feelings.
Collapse
Affiliation(s)
- Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Livia Quintiliani
- Psicologia Clinica, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Martina Ulivi
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| |
Collapse
|
85
|
Hajisabbagh N, Fereidooni-Moghadam M, Masoudi R, Etemadifar M. The effect of an emotional intelligence component program on happiness in patients with epilepsy. Epilepsy Behav 2020; 106:106972. [PMID: 32179502 DOI: 10.1016/j.yebeh.2020.106972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 01/11/2023]
Abstract
UNLABELLED Emotional intelligence is a psychological component that may affect happiness level in patients with epilepsy. Given the high prevalence of depression in patients with epilepsy, as well as the limitations of studies in this regard in Iran, the aim of this study was to investigate the effect of an emotional intelligence component program on happiness in patients with epilepsy. METHODS This randomized clinical trial study conducted on 70 patients with epilepsy who were randomly divided into two experimental and control groups of 35 patients. Emotional Intelligence Training Based on Bar-On Combined Model was provided in eight 90-minute sessions for eight weeks. Data were collected using a two-part questionnaire: demographic data and the Oxford Happiness Questionnaire (OHQ). RESULTS The mean age of the subjects was 33.3 ± 10.4 years in the intervention group and 34.4 ± 9.3 years in the control group. The independent t-test results showed no significant difference between the two groups before the intervention (p = 0.195). The Mann-Whitney test results showed a significant difference between the two groups after emotional intelligence training (p < 0.001). CONCLUSION Overall, the findings of this study showed that emotional intelligence training led to improvement of happiness in patients with epilepsy. According to the results of the study, it is suggested that training based on emotional intelligence components be used as an approach to improve happiness level in patients with epilepsy.
Collapse
Affiliation(s)
- Niloufar Hajisabbagh
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Malek Fereidooni-Moghadam
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Reza Masoudi
- Faculty of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | |
Collapse
|
86
|
Briggs FBS, Wilson BK, Pyatka N, Colón-Zimmermann K, Sajatovic MM. Effects of a remotely delivered group-format epilepsy self-management program on adverse health outcomes in vulnerable people with epilepsy: A causal mediation analysis. Epilepsy Res 2020; 162:106303. [PMID: 32151965 PMCID: PMC8019153 DOI: 10.1016/j.eplepsyres.2020.106303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/31/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND People with epilepsy frequently experience negative health events (NHEs), such as emergency room visits or hospitalizations for epilepsy-related complications despite significant advances in care. We developed a novel remotely delivered group-format epilepsy self-management program ("Self-management for people with epilepsy and a history of negative health events"; SMART). In a 6-month randomized controlled trial (RCT), SMART participants had significant decreases in NHEs, as well changes in attitudes and behaviors compared to a wait-list (Sajatovic et al., 2018). This secondary analysis from the RCT characterizes the indirect causal effects of SMART on NHE improvements that may be mediated by specific improvements in self-management, self-efficacy, social support, quality of life, and depression symptom severity. METHODS Participants were adults with epilepsy and a NHE in the prior 6 months. There were 60 participants in each RCT arm (SMART versus wait-list) and assessments were conducted at baseline, 10 weeks and 24 weeks. The outcome was a binary variable measuring NHE improvement at week 24. A counterfactual-based mediation framework was used to determine whether improvements or changes in attitudes and behaviors at specific time points or across the study period, mediated the impact of SMART on NHE improvements. RESULTS At week 24, SMART contributed to significant improvements in NHEs compared to those in wait-list (odds ratio = 3.2, p = 0.015). SMART was significantly associated with improvements and changes in aspects of self-management, self-efficacy, quality of life, and depression symptom severity at week 10, and significant improvements between baseline and week 24 in overall self-management and quality of life. Mediation analyses demonstrated that a portion of the effect (∼20-30 %; p < 0.05) of SMART on NHE improvement was also indirectly mediated by early improvements in depression symptom severity and quality of life. CONCLUSIONS This mediation analysis of the SMART intervention demonstrates that in addition to its direct effect on improving NHEs in people with epilepsy, early improvements in depression symptom severity and quality of life indirectly mediated ∼20-30 % of the intervention's effect. These results demonstrate the promise of self-management approaches as a key component of an optimal healthcare model for people with epilepsy, particularly those with a recent history of NHEs.
Collapse
Affiliation(s)
- Farren B S Briggs
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Betsy K Wilson
- Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Nataliya Pyatka
- University Hospitals Cleveland Medical Center Neurological Institute, Cleveland, Ohio, United States; Louis Stokes Veterans Affairs Cleveland Medical Center, Cleveland, Ohio, United States
| | - Kari Colón-Zimmermann
- Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Martha M Sajatovic
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States; Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States; University Hospitals Cleveland Medical Center Neurological Institute, Cleveland, Ohio, United States; Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States.
| |
Collapse
|
87
|
Ajinkya S, Fox J, Lekoubou A. Trends in prevalence and treatment of depressive symptoms in adult patients with epilepsy in the United States. Epilepsy Behav 2020; 105:106973. [PMID: 32163889 DOI: 10.1016/j.yebeh.2020.106973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/04/2020] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Depressive symptoms are a common comorbidity among adults with epilepsy (AWE). Prior estimates regarding prevalence and treatment of depressive symptoms in AWE have been largely based on samples of tertiary care cohorts that may not be generalizable. We aimed to provide a representative population estimate of the prevalence and treatment of depressive symptoms over time in AWE in the United States as measured by a validated depression screen. METHOD Data from the Medical Expenditure Panel Survey (MEPS) were analyzed from 2004 to 2015 to determine the prevalence of "screen positive" depressive symptoms (SPDS) among AWE as evaluated by the Patient Health Questionnaire-2 (PHQ-2). We defined pharmacotherapy for depressive symptoms as the prescription of any antidepressant, antipsychotic, anxiolytic, or central nervous system stimulant for the "Clinical Classification Code" of mood disorders within the year sampled, and psychotherapy as any outpatient or office-based visit for "mood disorders" for that year sampled. We analyzed temporal trends and explanatory variables for treatment using the Cochran-Armitage test and logistic regression, respectively. RESULTS Our sample included 2024 AWE, representing 1,736,023 patients nationwide. This included 517 AWE with SPDS (AWE-SPDS), representing 401,452 AWE, and 1507 AWE who screened negative for depressive symptoms (AWE-SNDS), representing 1,334,571 AWE. The prevalence of SPDS was 23.1% (95% confidence interval [CI]: 20.6%-25.8%). Women (odds ratio [OR]: 1.40, 95% CI: 1.05-1.87), patients ages 35-49 (OR: 1.83, 95% CI: 1.23-2.72; compared with patients ages 18-34), and patients with Charlson Comorbidity Index ≥1 (OR: 1.92, 95% CI: 1.41-2.61) had higher odds of SPDS. There was no significant change in depressive symptoms' prevalence or treatment in AWE between the epochs of 2004-2006 and 2013-2015. CONCLUSIONS Despite a quarter of AWE in the United States with SPDS, fewer than half received treatment. This indicates a need for improved efforts to screen AWE for depression and treat appropriately.
Collapse
Affiliation(s)
- Shaun Ajinkya
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - Jonah Fox
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Alain Lekoubou
- Department of Neurology, Penn State University Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
88
|
Błaszczyk B, Walczak A, Ścirka N, Konarzewska A, Miziak B, Czuczwar SJ. Pharmacological and non-pharmacological approaches to life threatening conditions in epilepsy. JOURNAL OF EPILEPTOLOGY 2020. [DOI: 10.21307/jepil-2020-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
89
|
Abstract
Stress is ubiquitous in chronic medical conditions; however, the connections to psychiatric and neurologic conditions are not always clearly established. Epilepsy is a unique illness that is intimately intertwined with stress and anxiety not only as a result of the disease process but also as a cause of disease exacerbation. Anxiety and depression also involve stress management and often overlap with epilepsy. Anxiety symptoms themselves may be present as intrinsic aspects of seizure phenomena, either during the events or closely related to them. The pathways of stress and anxiety involve the hypothalamic pituitary adrenal (HPA) axis and explain at least in part how stress may lead to worsening seizure control. Ultimately, the study of stress, anxiety, and epilepsy offers insight into mind and body connections, and furthers understanding of neuropsychiatric illness.
Collapse
|
90
|
Moser E, Chan F, Berven NL, Bezyak J, Iwanaga K, Umucu E. Resilience and life satisfaction in young adults with epilepsy: The role of person-environment contextual factors. JOURNAL OF VOCATIONAL REHABILITATION 2020. [DOI: 10.3233/jvr-191067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Erin Moser
- University of Northern Colorado, Greeley, CO, USA
| | - Fong Chan
- University of Wisconsin-Madison, Madison, WI, USA
| | | | - Jill Bezyak
- University of Northern Colorado, Greeley, CO, USA
| | | | - Emre Umucu
- University of Texas at El Paso, El Paso, TX, USA
| |
Collapse
|
91
|
Depression and anxiety in children with epilepsy and other chronic health conditions: National estimates of prevalence and risk factors. Epilepsy Behav 2020; 103:106828. [PMID: 31870808 PMCID: PMC7241646 DOI: 10.1016/j.yebeh.2019.106828] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study estimates the national prevalence of depression and anxiety among children with epilepsy and determines which demographic variables and comorbidities increase the risk of these psychopathologies. We also compare the rates of depression and anxiety in pediatric epilepsy with those of other chronic health conditions in childhood. METHODS We used the 2009-2010 National Survey of Children with Special Health Care Needs to identify children with epilepsy with and without depression and anxiety. We assessed demographic factors and comorbidities associated with depression and anxiety using weighted multivariable logistic regressions. The rates of psychiatric comorbidity in children with chronic conditions other than epilepsy were also determined. RESULTS The final sample included 1042 children over the age of five with epilepsy. After applying the sampling weights, we estimated that 283,000 children between 5 and 17 years of age have epilepsy in the United States (U.S.). Among these children, 25% have depression and/or anxiety. This figure was not significantly different from the rates seen among children with asthma (16.5%) or allergies (21.6%) but was significantly lower than the rate seen among children with migraines (43.2%). In our analyses of children with epilepsy, low-income children (regardless of race) and children whose needs for specialist care were unmet (relative to those whose needs were met) were more likely to have depression. Low-income black children were less likely to have anxiety than high-income white children. Gender, age, and epilepsy severity were unrelated to depression or anxiety. CONCLUSIONS One in four U.S. children with epilepsy has depression and/or anxiety. Therefore, physicians should consider the various factors that are related to depression and anxiety in children with epilepsy so that at-risk children can be screened and managed appropriately.
Collapse
|
92
|
Tareke M, Birehanu M, Amare D, Abate A. Common mental illness among epilepsy patients in Bahir Dar city, Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0227854. [PMID: 31971965 PMCID: PMC6977727 DOI: 10.1371/journal.pone.0227854] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Common mental illness has a substantial impact on seizure control and negatively affects the overall quality of life among individuals with epilepsy. However, there is a dearth of studies that examined the associated factors of common mental illness among epilepsy patients in Ethiopia, particularly in the study area. This study aimed to assess the magnitude and factors associated with common mental disorders in epilepsy patients who attended government health institutions in Bahir Dar city, Ethiopia. METHOD Health institution based cross-sectional study was conducted using a systematic sampling technique among people living with epilepsy in Bahir Dar City Administration. Common mental illness was assessed using a self-reporting questionnaire and a semi-structured questionnaire was employed to collect data on socio-demographic and clinical related characteristics. Data were analyzed using descriptive statistics, univariate logistic regression, and multivariable logistic regression. RESULTS The magnitude of comorbid common mental illness among people living with epilepsy was found 35.4%. High magnitude of common mental illness was reported among females (39.9%) when compared to males (32.3%). The most prevalent common mental disorders symptoms include being worried, unhappy feeling, trouble thinking clearly, and difficult to enjoy daily activities. Family history of epilepsy, frequent seizures attacks, side effects of antiepileptic drugs, lack of social support and not adherent to antiepileptic drugs were factors associated with common mental illness. CONCLUSIONS Common mental illness was found to be prevalent among people living with epilepsy. Therefore, it is recommended that great attention should be given to mental illness besides controlling seizure attacks.
Collapse
Affiliation(s)
- Minale Tareke
- Psychiatry Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Minychil Birehanu
- Nursing Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desalegne Amare
- Nursing Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Andargie Abate
- Nursing Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
93
|
Blixen C, Ogede D, Briggs F, Aebi ME, Burant C, Wilson B, Ponce Terashima J, Sajatovic M. Correlates of Stigma in People with Epilepsy. J Clin Neurol 2020; 16:423-432. [PMID: 32657063 PMCID: PMC7354984 DOI: 10.3988/jcn.2020.16.3.423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Epilepsy is often associated with substantial stigma. This study evaluated clinical correlates of stigma in a sample of people living with epilepsy (PLWE) considered high risk due to frequent seizures or other negative health events. Methods Data were derived from an epilepsy self-management clinical trial. Standardized measures assessed socio-demographics, epilepsy stigma, epilepsy severity, self-efficacy, self-management competency, health literacy, depressive symptoms severity, functional status, social support and quality of life. Results There were 120 individuals, mean age of 41.73 (SD=17.08), 81 men (66.9%), and 79 (65.3%) African-American. Individual factors correlated with worse stigma w ere indicative of more severe or poorly controlled seizures (frequent seizures, worse seizure severity scores, more antiepileptic drugs), mental health comorbidity (worse depression severity, other comorbidities) and factors related to individual functioning and perceived competency in managing their health (health literacy, health functioning, self-efficacy, quality of life). Multivariable linear regression found that worse quality of life, and having a mental condition were associated with more stigma (β=6.4 and 6.8, respectively), while higher self-efficacy, health literacy and social support were associated with less stigma (β=−0.06, −2.1, and −0.3, respectively). These five variables explained 50% of stigma variation. Conclusions Stigma burden can be substantial among PLWE and may vary depending on contextual factors such as mental health comorbidity. Care approaches that screen for psychiatric comorbidities, address low health literacy, institute promising self-management programs, and employ effective health communication strategies about epilepsy misconceptions, may reduce epilepsy related burden.
Collapse
Affiliation(s)
- Carol Blixen
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Daisy Ogede
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Michelle E Aebi
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher Burant
- Frances Payne Bolton School of Nursing, Case Western Reserve University and Louis Stokes VAMC, Cleveland, OH, USA
| | - Betsy Wilson
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Javier Ponce Terashima
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry and Neurology, Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
94
|
Abstract
Psychiatric illnesses, including depression and anxiety, are highly comorbid with epilepsy (for review see Josephson and Jetté (Int Rev Psychiatry 29:409-424, 2017), Salpekar and Mula (Epilepsy Behav 98:293-297, 2019)). Psychiatric comorbidities negatively impact the quality of life of patients (Johnson et al., Epilepsia 45:544-550, 2004; Cramer et al., Epilepsy Behav 4:515-521, 2003) and present a significant challenge to treating patients with epilepsy (Hitiris et al., Epilepsy Res 75:192-196, 2007; Petrovski et al., Neurology 75:1015-1021, 2010; Fazel et al., Lancet 382:1646-1654, 2013) (for review see Kanner (Seizure 49:79-82, 2017)). It has long been acknowledged that there is an association between psychiatric illnesses and epilepsy. Hippocrates, in the fourth-fifth century B.C., considered epilepsy and melancholia to be closely related in which he writes that "melancholics ordinarily become epileptics, and epileptics, melancholics" (Lewis, J Ment Sci 80:1-42, 1934). The Babylonians also recognized the frequency of psychosis in patients with epilepsy (Reynolds and Kinnier Wilson, Epilepsia 49:1488-1490, 2008). Despite the fact that the relationship between psychiatric comorbidities and epilepsy has been recognized for thousands of years, psychiatric illnesses in people with epilepsy still commonly go undiagnosed and untreated (Hermann et al., Epilepsia 41(Suppl 2):S31-S41, 2000) and systematic research in this area is still lacking (Devinsky, Epilepsy Behav 4(Suppl 4):S2-S10, 2003). Thus, although it is clear that these are not new issues, there is a need for improvements in the screening and management of patients with psychiatric comorbidities in epilepsy (Lopez et al., Epilepsy Behav 98:302-305, 2019) and progress is needed to understand the underlying neurobiology contributing to these comorbid conditions. To that end, this chapter will raise awareness regarding the scope of the problem as it relates to comorbid psychiatric illnesses and epilepsy and review our current understanding of the potential mechanisms contributing to these comorbidities, focusing on both basic science and clinical research findings.
Collapse
|
95
|
Wang L, Chen S, Liu C, Lin W, Huang H. Factors for cognitive impairment in adult epileptic patients. Brain Behav 2020; 10:e01475. [PMID: 31863643 PMCID: PMC6955925 DOI: 10.1002/brb3.1475] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To analyze factors for cognitive impairment in epileptic patients. METHODS A total of 257 epileptic patients completed clinical memory scale (CMS) and 70 of them were further surveyed with mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), digital symbol test (DSy), verbal fluency test, digit span test (DSp), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). Monadic linear related analysis and multiple stepwise regression analysis were performed to evaluate the potential factors for cognitive impairment. RESULTS Educational level was correlated with scores of cognitive tests (p < .01), with a difference between the junior high school group and senior high school group (p < .01 or p < .05). Seizure frequency was negatively correlated with CMS scores (p < .01), with a difference between the group with a seizure frequency of less than once a year and other groups (p < .01). The kind of antiepileptic drugs (AEDs) was negatively correlated with CMS scores (p < .01), with a difference between the single-drug group and the group taking more than two kinds of AEDs (p < .01). Depression scores were negatively correlated with MMSE, MoCA, DSy, DSp (p < .01 or p < .05), disease duration negatively with DSy (p < .01), and age negatively with MoCA (p < .05). Seizure type was correlated with DSy, and general seizure fared worse in the tests than other seizure types (p < .05). CONCLUSION Educational level, seizure frequency, kinds of AEDs and depression can affect the cognitive function of epileptic patients. High educational level, good seizure control, single-drug treatment and healthy psychological state are protective factors for cognitive function of epileptic patients.
Collapse
Affiliation(s)
- Lei Wang
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiac Surgery, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Shenggen Chen
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Changyun Liu
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Wanhui Lin
- Department of Neurology and Geriatrics, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Huapin Huang
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
| |
Collapse
|
96
|
Han SH, Kim KT, Ryu HU, Lee SA, Cho YJ, Kim JH, Kang KW, Shin DJ, Lee GH, Hwang KJ, Kim YS, Kim JB, Kim JE, Lee SY, Seo JG. Factors associated with social anxiety in South Korean adults with epilepsy. Epilepsy Behav 2019; 101:106569. [PMID: 31675602 DOI: 10.1016/j.yebeh.2019.106569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to examine social anxiety in South Korean adults with epilepsy and to identify associated factors. METHOD This was a cross-sectional, multicenter study in South Korea. Social anxiety was assessed using short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). The SPS-6 scores ≥9 and SIAS-6 scores ≥12 were considered indicative of social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9 (PHQ-9); Stigma Scale-Revised (SS-R); Disclosure Management Scale; Family Adaptation, Partnership, Growth, Affection, Resolve (F-APGAR) scale; and a questionnaire assessing knowledge about epilepsy were also used. RESULTS Of a total of 219 patients with epilepsy, 21% and 11% had SPS-6 scores ≥9 and SIAS-6 scores ≥12, respectively. In logistic regression analysis, SPS-6 scores ≥9 were independently associated with SS-R scores of 4-9 (odds ratio [OR]: 8.626, 95% confidence interval [CI]: 2.515-29.587, p = .001), SS-R scores 1-3 (OR: 5.496, 95% CI: 1.757-17.197, p = .003), and PHQ-9 scores ≥10 (OR: 4.092, 95% CI: 1.823-9.185, p = .001). In contrast, SIAS-6 scores ≥12 were related only to PHQ-9 scores ≥10 (OR: 8.740, 95% CI: 3.237-23.599, p < .001). Belonging to a dysfunctional family and lack of knowledge about epilepsy tended to be associated with social phobia (p = .071) and social interaction anxiety (p = .090), respectively. Epilepsy-related variables were not related to social anxiety. CONCLUSION Social anxiety is not rare in patients with epilepsy. In this study, social phobia was associated with perceived stigma and depressive symptoms, whereas social interaction anxiety was related only to depressive symptoms in patients with epilepsy.
Collapse
Affiliation(s)
- Su-Hyun Han
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Han Uk Ryu
- Department of Neurology, Chonbuk National University School of Medicine, Jeonju, Republic of Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Yang-Je Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Hyun Kim
- Department Neurology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Kyung-Wook Kang
- Department of Neurology, Chonnam National University Hospital, Kwangju, Republic of Korea
| | - Dong Jin Shin
- Department of Neurology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | - Gha Hyun Lee
- Departments of Neurology, Pusan National University School of Medicine, Pusan, Republic of Korea
| | - Kyoung Jin Hwang
- Department of Neurology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young-Soo Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Jung Bin Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji-Eun Kim
- Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Seo-Young Lee
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| |
Collapse
|
97
|
Tetuan C, Axon DR, Bingham J, Boesen K, Lipsy R, Scovis N, Taylor AM, Warholak T, Lott BE, Leal S. Assessing the Effect of a Telepharmacist's Recommendations During an Integrated, Interprofessional Telehealth Appointment and Their Alignment with Quality Measures. J Manag Care Spec Pharm 2019; 25:1334-1339. [PMID: 31778622 PMCID: PMC10397946 DOI: 10.18553/jmcp.2019.25.12.1334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A growing provider shortage contributes to the widening gap in significant disparities that rural communities face. To expand access to care for rural-dwelling patients with epilepsy, a national nonprofit organization initiated an integrated, interprofessional telehealth program. OBJECTIVE To identify gaps in care based on a telepharmacist's recommendations and determine whether these recommendations aligned with Health Effectiveness Data Information Set (HEDIS) performance measures. METHODS A retrospective chart review was conducted for patients who had an appointment with an integrated interprofessional care team composed of an epileptologist, a social worker, registered nurses, and a pharmacist. This novel approach integrated provision of care by team members at geographically distinct remote locations. The pharmacist conducted comprehensive medical reviews via video conferencing and made recommendations to the epileptologist, primary care provider, and/or patient, as appropriate. The consultation was documented in the electronic health record (EHR). The pharmacist's recommendations were categorized as 1 of the 24 preselected HEDIS performance measures or as a non-HEDIS measure. The analysis used descriptive statistics to report patient demographics and pharmacist recommendations. RESULTS This study included 86 participants. 86 initial and 36 follow-up appointments were conducted between April 2016 and October 2017. The majority of patients were female (52%), with a mean age of 26.2 years (SD = 14.6, range 4-76) and were taking an average of 6.1 medications (SD = 3.6). 159 comorbidities or conditions were identified in the EHR along with 306 recommendations, for an average of 3.6 recommendations per patient (SD = 3.2). 41 (13.4%) recommendations aligned with preselected HEDIS measures, including medication management for depression (31.7%), hypertension (24.4%), asthma (9.8%), and comprehensive adult diabetes care (14.6%). The remaining 265 recommendations lacked sufficient documentation for categorization or failed to align with any targeted measure. CONCLUSIONS This retrospective analysis showed that only 13% of pharmacist recommendations aligned with HEDIS quality measures. While it demonstrates the added value of clinical pharmacists in novel telehealth approaches, future work is needed to develop strategies to increase the number of recommendations aligning with HEDIS measures that adhere to national consensus treatment guidelines via telepharmacist training and improved documentation. DISCLOSURES SinfoníaRx provided funding for this project through a grant to Warholak, Taylor, Axon, and Lott. Bingham, Boesen, Scovis, and Leal are employed by SinfoníaRx. Data from this study were presented at the American Society of Health-System Pharmacists Ambulatory Care Conference 2018; June 4, 2018; Denver, CO, and the Southwestern States Residency Conference 2018; June 15, 2018; Chandler, AZ.
Collapse
Affiliation(s)
- Christa Tetuan
- Medication Management Center, University of Arizona College of Pharmacy, Tucson
| | | | | | | | - Robert Lipsy
- Medication Management Center, University of Arizona College of Pharmacy, Tucson
| | | | | | | | | | | |
Collapse
|
98
|
Margolis SA, Gonzalez JS, Faria C, Kenney L, Grant AC, Nakhutina L. Anxiety disorders in predominantly African American and Caribbean American adults with intractable epilepsy: The role of perceived epilepsy stigma. Epilepsy Behav 2019; 99:106450. [PMID: 31419635 DOI: 10.1016/j.yebeh.2019.106450] [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: 05/31/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Anxiety disproportionately affects people with epilepsy (PWE) and leads to poor outcomes. Yet, risk factors are not well understood especially among underserved groups. This cross-sectional study aimed to identify epilepsy-specific predictors of anxiety disorders in predominantly African American and Caribbean American PWE. MATERIALS AND METHODS The prevalence of anxiety disorders was established via diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)). We identified the extent to which aspects of seizure burden (seizure frequency, seizure severity, convulsive vs. nonconvulsive seizures), seizure worry, and perceived epilepsy stigma were associated with anxiety disorder diagnosis. Finally, logistic regression assessed the overall and independent contributions of significant risk factors. RESULTS There were 60 participants (62% women, 52% African American, 27% Caribbean American, 20% Hispanic/Latino) with an average of 2 seizures per month. Nearly half of the sample (43%) had ≥1 anxiety disorder, with 62% of affected individuals qualifying for agoraphobia. Those with anxiety disorders tended to have convulsive seizures (p = 0.037) and endorsed greater seizure worry (p = 0.012), more general symptoms of anxiety (p = 0.005), and worse perceived epilepsy stigma (p = 0.003). Logistic regression accounted for 28% to 37.6% of the variance in anxiety disorder diagnostic status and correctly classified 73% of cases; however, only perceived epilepsy stigma made a unique contribution. CONCLUSIONS Anxiety disorders were prevalent in these predominantly African American and Caribbean American PWE. Epilepsy-specific risk factors included convulsive seizures, seizure worry, and perceived epilepsy stigma. Interventions aimed at treating anxiety disorders in diverse PWE may especially benefit from targeting stigma beliefs.
Collapse
Affiliation(s)
- Seth A Margolis
- Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA.
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., Bronx, NY 10461, USA; Albert Einstein College of Medicine, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10461, USA
| | - Caylin Faria
- Bridgewater State University, 131 Summer St., Bridgewater, MA 02324, USA
| | - Lauren Kenney
- Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Arthur C Grant
- State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA
| | - Luba Nakhutina
- State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA
| |
Collapse
|
99
|
Watson F, Packer RMA, Rusbridge C, Volk HA. Behavioural changes in dogs with idiopathic epilepsy. Vet Rec 2019; 186:93. [PMID: 31554714 DOI: 10.1136/vr.105222] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 07/28/2019] [Accepted: 08/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Breed-specific and broader cohort studies have shown behavioural changes in dogs following the onset of idiopathic epilepsy (IE). METHODS A cross-sectional, case-control questionnaire study was carried out to strengthen this body of evidence. Owners of eight breeds of dog completed an online questionnaire about their dogs' behaviour; once for control dogs and twice for dogs with IE, for both pre-IE and post-IE onset behaviour. RESULTS Ninety-six (24.74 per cent) dogs with IE and 292 (75.26 per cent) age and breed-matched control dogs met the inclusion criteria. Control dogs had significantly higher 'Trainability' scores than dogs with IE (P=0.04). After IE, dogs had significantly higher 'Dog-Directed Fear or Aggression' (P=0.02), 'Non-Social Fear' (P=0.01), 'Attachment/Attention-Seeking Behaviour' (P=0.04), 'Attention-Deficit' (P=0.02) and significantly lower 'Trainability' (P=0.02) than prior to the onset of IE. Medication status did not significantly affect any behavioural factor, but drug-resistant dogs had significantly less 'Trainability' than drug-responsive (P=0.04) and partially drug-responsive dogs (P=0.03). CONCLUSION Behavioural differences related to cognitive function are seen between dogs with IE and controls. Behavioural changes related to anxiety, attention and cognition are seen in dogs following the onset of IE. The ability to clinically define and diagnose behavioural comorbidities in dogs is much needed from both a clinical and research perspective.
Collapse
Affiliation(s)
- Fraje Watson
- Fitzpatrick Referrals Orthopaedics and Neurology, Godalming, UK .,Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, Hatfield, UK
| | | | - Clare Rusbridge
- Fitzpatrick Referrals Orthopaedics and Neurology, Godalming, UK.,School of Veterinary Medicine, University of Surrey, Guildford, Surrey, UK
| | - Holger Andreas Volk
- Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, Hatfield, UK.,Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| |
Collapse
|
100
|
Pańczyk K, Pytka K, Jakubczyk M, Rapacz A, Siwek A, Głuch‐Lutwin M, Gryboś A, Słoczyńska K, Koczurkiewicz P, Ryszawy D, Pękala E, Budziszewska B, Starek‐Świechowicz B, Suraj‐Prażmowska J, Walczak M, Żesławska E, Nitek W, Bucki A, Kołaczkowski M, Żelaszczyk D, Francik R, Marona H, Waszkielewicz AM. Synthesis of
N
‐(phenoxyalkyl)‐,
N
‐{2‐[2‐(phenoxy)ethoxy]ethyl}‐ or
N
‐(phenoxyacetyl)piperazine Derivatives and Their Activity Within the Central Nervous System. ChemistrySelect 2019. [DOI: 10.1002/slct.201902648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Katarzyna Pańczyk
- Department of Bioorganic ChemistryChair of Organic ChemistryFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Karolina Pytka
- Department of PharmacodynamicsFaculty of PharmacyJagiellonian University Medical College, Medyczna 9 30-688 Krakow Poland
| | - Magdalena Jakubczyk
- Department of PharmacodynamicsFaculty of PharmacyJagiellonian University Medical College, Medyczna 9 30-688 Krakow Poland
| | - Anna Rapacz
- Department of PharmacodynamicsFaculty of PharmacyJagiellonian University Medical College, Medyczna 9 30-688 Krakow Poland
| | - Agata Siwek
- Department of PharmacobiologyFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Monika Głuch‐Lutwin
- Department of PharmacobiologyFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Anna Gryboś
- Department of PharmacobiologyFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Karolina Słoczyńska
- Department of Pharmaceutical BiochemistryFaculty of PharmacyJagiellonian University Medical College, Medyczna 9 30-688 Krakow Poland
| | - Paulina Koczurkiewicz
- Department of Pharmaceutical BiochemistryFaculty of PharmacyJagiellonian University Medical College, Medyczna 9 30-688 Krakow Poland
| | - Damian Ryszawy
- Department of Cell BiologyFaculty of Biochemistry, Biophysics and BiotechnologyJagiellonian University, Gronostajowa 7 30-387 Krakow Poland
| | - Elżbieta Pękala
- Department of Pharmaceutical BiochemistryFaculty of PharmacyJagiellonian University Medical College, Medyczna 9 30-688 Krakow Poland
| | - Bogusława Budziszewska
- Department of Biochemical ToxicologyFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Beata Starek‐Świechowicz
- Department of Biochemical ToxicologyFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Joanna Suraj‐Prażmowska
- Jagiellonian Centre for Experimental Therapeutics (JCET)Jagiellonian University, Bobrzynskiego 14, 30–348 Krakow Poland, Chair and Department of Toxicology, Faculty of Pharmacy, Jagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Maria Walczak
- Jagiellonian Centre for Experimental Therapeutics (JCET)Jagiellonian University, Bobrzynskiego 14, 30–348 Krakow Poland, Chair and Department of Toxicology, Faculty of Pharmacy, Jagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Ewa Żesławska
- Department of ChemistryInstitute of BiologyPedagogical University Podchorążych 2, 30–084 Krakow Poland
| | - Wojciech Nitek
- Faculty of ChemistryJagiellonian University Gronostajowa 2 30-387 Krakow Poland
| | - Adam Bucki
- Department of Medicinal ChemistryChair of Pharmaceutical ChemistryFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Marcin Kołaczkowski
- Department of Medicinal ChemistryChair of Pharmaceutical ChemistryFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Dorota Żelaszczyk
- Department of Bioorganic ChemistryChair of Organic ChemistryFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Renata Francik
- Department of Bioorganic ChemistryChair of Organic ChemistryFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Henryk Marona
- Department of Bioorganic ChemistryChair of Organic ChemistryFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| | - Anna M. Waszkielewicz
- Department of Bioorganic ChemistryChair of Organic ChemistryFaculty of PharmacyJagiellonian University Medical College Medyczna 9 30-688 Krakow Poland
| |
Collapse
|