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Pazgan-Simon M, Jaroszewicz J, Simon K, Lorenc B, Sitko M, Zarębska-Michaluk D, Dybowska D, Tudrujek-Zdunek M, Berak H, Mazur W, Klapaczyński J, Janczewska E, Parfieniuk-Kowerda A, Flisiak R. Real-World Effectiveness and Safety of Direct-Acting Antivirals in Patients with Chronic Hepatitis C and Epilepsy: An Epi-Ter-2 Study in Poland. J Pers Med 2023; 13:1111. [PMID: 37511724 PMCID: PMC10381851 DOI: 10.3390/jpm13071111] [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: 06/06/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION In Poland, active HCV infection affects between 0.4 and 0.5% of the population, i.e., about 150,000 people, while the number of patients with epilepsy is estimated to be 350,000-400,000. Currently available antiviral therapies show little interaction with neurological drugs. The aim of our study was to evaluate the effectiveness and safety of the treatment of chronic HCV infection in patients with coexisting epilepsy. METHODS A total of 184 epilepsy patients were selected from the group of 10,152 HCV-infected patients treated for HCV infection within the Epiter-2 database from 2015 to 2018. Comparing the effectiveness and safety of anti-HCV regimens between the patients with comorbid epilepsy and 3573 patients without comorbidities was our study's objective. RESULTS The effectiveness of anti-HCV treatment was high in both the sample and the control group. No statistically significant SVR difference was observed between the sample group, with ITT = 93.5% and mITT = 95.5%, and the control group, with ITT = 95.2% and mITT = 97.5%, regardless of the genotype and the stage of liver disease at the start of therapy. The treatment was safe in patients with epilepsy. CONCLUSIONS The effectiveness and safety of HCV treatment in patients with epilepsy are comparable to those of patients with no significant comorbidities.
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Affiliation(s)
- Monika Pazgan-Simon
- Department of Infectious Diseases, Regional Specialistic Hospital, 50-149 Wrocław, Poland
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia in Katowice, 41-902 Bytom, Poland
| | - Krzysztof Simon
- Department of Infectious Diseases, Regional Specialistic Hospital, 50-149 Wrocław, Poland
- Department of Infectious Diseases and Hepatology, Wroclaw Medical University, 51-149 Wrocław, Poland
| | - Beata Lorenc
- Department of Infectious Diseases, Pomeranian Center of Infectious Diseases, University of Gdansk, 80-210 Gdańsk, Poland
| | - Marek Sitko
- Department of Infectious and Tropical Diseases, Collegium Medicum, Jagiellonian University, 30-252 Kraków, Poland
| | - Dorota Zarębska-Michaluk
- Department of Infectious Disease, Voivodeship Hospital, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Dorota Dybowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Nicolaus Copernicus University, 87-100 Bydgoszcz, Poland
| | | | - Hanna Berak
- Hospital for Infectious Diseases, Warsaw Medical University, 02-091 Warszawa, Poland
| | - Włodzimierz Mazur
- Clinical Department of Infectious Diseases, Medical University of Silesia, 40-055 Chorzów, Poland
| | - Jakub Klapaczyński
- Department of Internal Medicine and Hepatology, Central Clinical Hospital of Internal Affairs and Administration, 02-241 Warszawa, Poland
| | - Ewa Janczewska
- Department of Basic Medical Sciences, School of Public Health in Bytom, Medical University of Silesia, 40-055 Bytom, Poland
- ID Clinic, Hepatology Outpatient Department, 41-400 Mysłowice, Poland
| | - Anna Parfieniuk-Kowerda
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Białystok, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Białystok, Poland
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Gaitatzis A, Majeed A. Multimorbidity in People with Epilepsy. Seizure 2023; 107:136-145. [PMID: 37023627 DOI: 10.1016/j.seizure.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Multimorbidity is an emerging priority in healthcare due to associations with the ageing population, frailty, polypharmacy, health and social care demands. It affects 60-70% of adults and 80% of children with epilepsy. Neurodevelopmental conditions are commonly seen in children with epilepsy, while cancer, cardiovascular and neurodegenerative conditions often afflict older people with epilepsy. Mental health problems are common across the lifespan. Genetic, environmental, social and lifestyle factors contribute to multimorbidity and its consequences. Multimorbid people with epilepsy (PWE) are at higher risk of depression and suicide, premature death, suffer lower health-related quality of life, and require more hospital admissions and health care costs. The best management of multimorbid PWE requires a paradigm shift from the traditional single disease-single comorbidity approach and a refocus on a person-centred approach. Improvements in health care must be informed by assessing the burden of multimorbidity associated with epilepsy, delineating disease clusters, and measuring the effects on health outcomes.
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Takano T. Self-injury as a predominant challenging behavior in epilepsy: A study in a residential facility for profoundly disabled patients. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 120:104149. [PMID: 34922088 DOI: 10.1016/j.ridd.2021.104149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The association between challenging behavior (CB) and epilepsy in people with intellectual disability (ID) remains largely controversial. AIM To clarify the correlation between CB and epilepsy, we investigated the clinical characteristics of CB in both people with and without epilepsy among individuals with ID hospitalized in our residential facility. METHODS AND PROCEDURES A total of 63 individuals with CB was retrospectively investigated using the Behavior Problems Inventory, and the following items were collected from the medical records: sex, age, hospitalization period, etiology and risk factors, level of ID, type of CB, administration of psychotropic drugs, presence or absence of epilepsy and clinical features of epilepsy. OUTCOMES AND RESULTS Almost all individuals with CB showed profound ID. There was no significant difference in the rate of CB between people with and without epilepsy. A type analysis of CB revealed that self-injurious behavior was observed more frequently in epilepsy cases (66.7 %) than in cases without epilepsy (36.4 %) (p = 0.015), and self-injurious behavior was the predominant clinical form in people with epilepsy among the three subgroups of CB (self-injurious, aggressive and self-injurious and aggressive behavior). CONCLUSIONS AND IMPLICATIONS The high incidence of self-injurious behavior in epilepsy with profound disabilities may imply the presence of common pathological basis of self-injurious behavior and epilepsy.
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Affiliation(s)
- Tomoyuki Takano
- Department of Pediatrics, Biwako-Gakuen Medical and Welfare Center of Yasu, 978-2 Kitazakura, Yasu, 520-2321, Japan; Department of Pediatrics, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, 520-2192, Japan.
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Reichard J, Zimmer-Bensch G. The Epigenome in Neurodevelopmental Disorders. Front Neurosci 2021; 15:776809. [PMID: 34803599 PMCID: PMC8595945 DOI: 10.3389/fnins.2021.776809] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022] Open
Abstract
Neurodevelopmental diseases (NDDs), such as autism spectrum disorders, epilepsy, and schizophrenia, are characterized by diverse facets of neurological and psychiatric symptoms, differing in etiology, onset and severity. Such symptoms include mental delay, cognitive and language impairments, or restrictions to adaptive and social behavior. Nevertheless, all have in common that critical milestones of brain development are disrupted, leading to functional deficits of the central nervous system and clinical manifestation in child- or adulthood. To approach how the different development-associated neuropathologies can occur and which risk factors or critical processes are involved in provoking higher susceptibility for such diseases, a detailed understanding of the mechanisms underlying proper brain formation is required. NDDs rely on deficits in neuronal identity, proportion or function, whereby a defective development of the cerebral cortex, the seat of higher cognitive functions, is implicated in numerous disorders. Such deficits can be provoked by genetic and environmental factors during corticogenesis. Thereby, epigenetic mechanisms can act as an interface between external stimuli and the genome, since they are known to be responsive to external stimuli also in cortical neurons. In line with that, DNA methylation, histone modifications/variants, ATP-dependent chromatin remodeling, as well as regulatory non-coding RNAs regulate diverse aspects of neuronal development, and alterations in epigenomic marks have been associated with NDDs of varying phenotypes. Here, we provide an overview of essential steps of mammalian corticogenesis, and discuss the role of epigenetic mechanisms assumed to contribute to pathophysiological aspects of NDDs, when being disrupted.
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Affiliation(s)
- Julia Reichard
- Functional Epigenetics in the Animal Model, Institute for Biology II, RWTH Aachen University, Aachen, Germany
- Research Training Group 2416 MultiSenses-MultiScales, Institute for Biology II, RWTH Aachen University, Aachen, Germany
| | - Geraldine Zimmer-Bensch
- Functional Epigenetics in the Animal Model, Institute for Biology II, RWTH Aachen University, Aachen, Germany
- Research Training Group 2416 MultiSenses-MultiScales, Institute for Biology II, RWTH Aachen University, Aachen, Germany
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Gorton HC, Webb RT, Parisi R, Carr MJ, DelPozo-Banos M, Moriarty KJ, Pickrell WO, John A, Ashcroft DM. Alcohol-Specific Mortality in People With Epilepsy: Cohort Studies in Two Independent Population-Based Datasets. Front Neurol 2021; 11:623139. [PMID: 33551978 PMCID: PMC7859425 DOI: 10.3389/fneur.2020.623139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: The risk of dying by alcohol-specific causes in people with epilepsy has seldom been reported from population-based studies. We aimed to estimate the relative risk of alcohol-specific mortality in people with epilepsy, and the extent to which problematic alcohol use was previously identified in the patients' medical records. Method: We delineated cohort studies in two population-based datasets, the Clinical Practice Research Datalink (CPRD GOLD) in England (January 01, 2001–December 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (January 01, 2001–December 31, 2014), linked to hospitalization and mortality records. People with epilepsy were matched to up to 20 persons without epilepsy on gender, age (±2 years) and registered general practice. We identified alcohol-specific death from Office for National Statistics (ONS) records using specified ICD-10 codes. We further identified prescriptions, interventions and hospitalisations related to alcohol use. Results: In the CPRD GOLD, we identified 9,871 individuals in the incident epilepsy cohort and 185,800 in the comparison cohort and, in the SAIL Databank, these numbers were 5,569 and 110,021, respectively. We identified a five-fold increased risk of alcohol-specific mortality in people with epilepsy vs. those without the condition in our pooled estimate across the two datasets (deprivation-adjusted HR 4.85, 95%CI 3.46–6.79). Conclusions: People with epilepsy are at increased risk of dying by an alcohol-specific cause than those without the disorder. It is plausible that serious alcohol misuse could either contribute to the development of epilepsy or it could commence subsequent to epilepsy being diagnosed. Regardless of the direction of the association, it is important that the risk of dying as a consequence of alcohol misuse is accurately quantified in people affected by epilepsy. Systematically-applied, sensitive assessment of alcohol consumption by healthcare professionals, at opportunistic, clinical contacts, with rapid access to quality treatment services, should be mandatory and play a key role in reduction of health harms and mortality.
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Affiliation(s)
- Hayley C Gorton
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom.,Division of Psychology & Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre (MAHSC), Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Rosa Parisi
- Division of Informatics, Imaging & Data Sciences, Manchester Academic Health Sciences Centre (MAHSC), Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Matthew J Carr
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom.,Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Sciences Centre (MAHSC), Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | | | | | - W Owen Pickrell
- Neurology and Molecular Neuroscience Research Group, Swansea University Medical School, Swansea University, Swansea, United Kingdom.,Neurology Department, Morriston Hospital, Swansea Bay University Health Board, Swansea, United Kingdom
| | - Ann John
- Farr Institute, Swansea University Medical School, Swansea, United Kingdom
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom.,Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Sciences Centre (MAHSC), Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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The effects of a brief memory enhancement course on individuals with epilepsy. Epilepsy Behav 2020; 112:107347. [PMID: 32861025 DOI: 10.1016/j.yebeh.2020.107347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of the study was to determine whether a brief memory enhancement course in persons with epilepsy (PWE) can improve cognitive abilities, quality of life, self-management, and seizure severity. METHODS Thirty-nine PWE completed a 1-hour memory enhancement course. This was preceded by a baseline/preintervention assessment (BA/PRE), followed by postintervention assessment (POST) at 1 & 1/2 to 3 months, and a delayed postintervention assessment evaluation (DPOST) at 4 & 1/2 to 6 months after course completion. In order to assess for retesting bias, an additional 30 PWE underwent a separate BA and PRE. RESULTS There was significant improvement on the Patient-Reported Outcomes Patient Information System version 2.0 Cognitive Function Abilities Subset and the Epilepsy Self-Management Scale (ESMS) on both POST and DPOST when compared with BA/PRE. Retesting bias did not occur. On ESMS subscale evaluation, significant improvement occurred on the Lifestyle Management subscale. There was no improvement in quality of life and seizure severity. There was good patient acceptability for the memory program. CONCLUSION A brief memory enhancement course results in sustained improvement in cognitive functioning and self-management of PWE.
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Mekonen T, Getnet A, Belete A, Menberu M, Fekadu W. Suicidal behavior among people with epilepsy in Northwest Ethiopia: A comparative cross-sectional study. Epilepsy Behav 2020; 111:107233. [PMID: 32563892 DOI: 10.1016/j.yebeh.2020.107233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/06/2020] [Accepted: 06/05/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Premature mortality is common in people with epilepsy, but the causes vary where suicide is considered as one of the commonest. OBJECTIVE The objective of this study was to compare suicidal behavior between people with epilepsy and the general population and identify associated factors in Northwest Ethiopia. METHODS We have conducted a comparative cross-sectional study in Northwest Ethiopia. We have selected people with epilepsy from outpatient departments and the comparisons from the general population. Suicidal behavior was assessed by the revised version of Suicidal Behaviors Questionnaire (SBQ-R). Logistic regression was implemented to look for associations between factors and the dependent variable. RESULTS The prevalence of suicidal behavior in people with epilepsy was 18.2%, significantly higher than the community sample, which was 9.8% (p-value = .001). This difference persists in the multivariable logistic regression model by which the odds of suicidal behavior in people with epilepsy was two times more as compared to the community sample. Other variables positively associated with suicidal behavior for the overall sample were depressive symptoms, no formal education, divorced/widowed marital status, and higher perceived criticism. Better social support was protective factor for suicidal behavior. CONCLUSION The proportion of suicidal behavior is twofold higher in people with epilepsy than the general population. Routine screening for suicide risk should be an integral part of epilepsy treatment.
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Affiliation(s)
- Tesfa Mekonen
- Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia; School of Psychology, University of Queensland, Australia.
| | - Asmamaw Getnet
- College of Health Sciences, Debre Markos University, Ethiopia
| | - Amsalu Belete
- College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
| | - Melak Menberu
- Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Wubalem Fekadu
- Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia; Department of Psychiatry, College of Health Sciences, Addis Ababa University, Ethiopia
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Zinchuk MS, Avedisova AS, Pashnin EV, Voinova NI, Guekht AB. [Suicidological research in epilepsy: problems of methodology]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:23-28. [PMID: 32207727 DOI: 10.17116/jnevro201911911223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review highlights contemporary views on the problem of suicide in patients with epilepsy. The most relevant theories are presented that describe the emergence of suicidal thoughts and the transition to suicidal attempts. Along with a description of risk factors, protective factors, as well as the possible impact of comorbidity, a description of methodological deficiencies in papers on suicide in patients with epilepsy is given. Recommendations for studies related to suicidal behaviour in patients with epilepsy are discussed.
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Affiliation(s)
- M S Zinchuk
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A S Avedisova
- Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russia
| | - E V Pashnin
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - N I Voinova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A B Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
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