1
|
Cano-López I, Catalán-Aguilar J, Lozano-García A, Hidalgo V, Hampel KG, Tormos-Pons P, Salvador A, Villanueva V, González-Bono E. Cognitive phenotypes in patients with drug-resistant temporal lobe epilepsy: Relationships with cortisol and affectivity. Clin Neuropsychol 2024:1-24. [PMID: 38965831 DOI: 10.1080/13854046.2024.2375605] [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: 04/28/2024] [Accepted: 06/28/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE Drug-resistant temporal lobe epilepsy (TLE) is a neurological disorder characterized by cognitive deficits. This study examined whether patients with TLE and different cognitive phenotypes differ in cortisol levels and affectivity while controlling for demographic and clinical variables. Methods: In this cross-sectional study, 79 adults with TLE underwent neuropsychological evaluation in which memory, language, attention/processing speed, executive function, and affectivity were assessed. Six saliva samples were collected in the afternoon to examine the ability of the hypothalamic-pituitary-adrenal (HPA) axis to descend according to the circadian rhythm (C1 to C6). The cortisol area under the curve concerning ground (AUCg) was computed to examine global cortisol secretion. RESULTS Three cognitive phenotypes were identified: memory impairment, generalized impairment, and no impairment. The memory-impairment phenotype showed higher cortisol levels at C4, C5, and C6 than the other groups (p = 0.03, η2 = 0.06), higher cortisol AUCg than the generalized-impairment phenotype (p = 0.004, η2 = 0.14), and a significant reduction in positive affectivity after the evaluation (p = 0.026, η2 = 0.11). Higher cortisol AUCg and reductions in positive affectivity were significant predictors of the memory-impairment phenotype (p < 0.001; Cox and Snell R2 = 0.47). CONCLUSIONS Patients with memory impairment had a slower decline in cortisol levels in the afternoon, which could be interpreted as an inability of the HPA axis to inhibit itself. Thus, chronic stress may influence hippocampus-dependent cognitive function more than other cognitive functions in patients with TLE.
Collapse
Affiliation(s)
- Irene Cano-López
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Judit Catalán-Aguilar
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Alejandro Lozano-García
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Department of Psychology, Universidad Europea de Valencia, Valencia, Spain
| | - Vanesa Hidalgo
- Department of Psychology and Sociology, Area of Psychobiology, Social and Human Sciences Center, University of Zaragoza, Teruel, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Paula Tormos-Pons
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Alicia Salvador
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Esperanza González-Bono
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| |
Collapse
|
2
|
Liu S, Cao Z, He Z, Shi W, Li J. Social support and the burden of physical and psychiatric comorbidities in the patients with late-onset epilepsy in China: A cross-sectional study. Epilepsy Behav 2024; 155:109775. [PMID: 38640724 DOI: 10.1016/j.yebeh.2024.109775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/05/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Epilepsy is the third most common neurological disorder in elderly people. Patients with epilepsy (PWEs) are more likely to have comorbidities. Social support is very important for PWEs. However, there are many gaps in the research on social support in older PWEs, especially the correlation between social support and comorbidities. METHODS A cross-sectional study was conducted in three hospitals in China. Social support was assessed using the Social Support Rate Scale. The burden of physical comorbidities was assessed using the CCI, and global disability was assessed using the mRS. The NDDIE was used to assess depression, the GAD7 was used for anxiety, the CDR was used for cognitive status, and the NPI was used for psychotic symptoms. RESULTS A total of 154 older PWEs participated in the study. There were 97 patients with at least one physical comorbidities. The burden of physical comorbidities was negatively correlated with overall social support (Adj. r = -0.35, P < 0.001) and global disability (Adj. r = -0.45, P < 0.001). In terms of psychiatric comorbidities, anxiety, depression, and cognitive status were not correlated with overall social support (Adj. r = -0.03, -0.02, and -0.11, P > 0.05). Psychotic symptoms were correlated with overall social support (Adj. r = -0.20, P < 0.05). The overall burden of psychiatric comorbidities was associated with overall social support (r = 0.30, P < 0.01). DISCUSSION Neurologists and social workers should consider more personalized biopsychosocial care to improve the quality of life of older PWEs.
Collapse
Affiliation(s)
- Shengyi Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhen Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Geriatrics, The Second People's Hospital of Yibin, Yibin, China.
| | - Zihua He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, China.
| | - Wenyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
3
|
Leeman-Markowski BA, Martin SP, Hardstone R, Tam DM, Devinsky O, Meador KJ. Novelty preference assessed by eye tracking: A sensitive measure of impaired recognition memory in epilepsy. Epilepsy Behav 2024; 155:109749. [PMID: 38636142 DOI: 10.1016/j.yebeh.2024.109749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Epilepsy patients often report memory deficits despite normal objective testing, suggesting that available measures are insensitive or that non-mnemonic factors are involved. The Visual Paired Comparison Task (VPCT) assesses novelty preference, the tendency to fixate on novel images rather than previously viewed items, requiring recognition memory for the "old" images. As novelty preference is a sensitive measure of hippocampal-dependent memory function, we predicted impaired VPCT performance in epilepsy patients compared to healthy controls. METHODS We assessed 26 healthy adult controls and 31 epilepsy patients (16 focal-onset, 13 generalized-onset, 2 unknown-onset) with the VPCT using delays of 2 or 30 s between encoding and recognition. Fifteen healthy controls and 17 epilepsy patients (10 focal-onset, 5 generalized-onset, 2 unknown-onset) completed the task at 2-, 5-, and 30-minute delays. Subjects also performed standard memory measures, including the Medical College of Georgia (MCG) Paragraph Test, California Verbal Learning Test-Second Edition (CVLT-II), and Brief Visual Memory Test-Revised (BVMT-R). RESULTS The epilepsy group was high functioning, with greater estimated IQ (p = 0.041), greater years of education (p = 0.034), and higher BVMT-R scores (p = 0.024) compared to controls. Both the control group and epilepsy cohort, as well as focal- and generalized-onset subgroups, had intact novelty preference at the 2- and 30-second delays (p-values ≤ 0.001) and declined at 30 min (p-values > 0.05). Only the epilepsy patients had early declines at 2- and 5-minute delays (controls with intact novelty preference at p = 0.003 and p ≤ 0.001, respectively; epilepsy groups' p-values > 0.05). CONCLUSIONS Memory for the "old" items decayed more rapidly in overall, focal-onset, and generalized-onset epilepsy groups. The VPCT detected deficits while standard memory measures were largely intact, suggesting that the VPCT may be a more sensitive measure of temporal lobe memory function than standard neuropsychological batteries.
Collapse
Affiliation(s)
- Beth A Leeman-Markowski
- Neurology Service, VA New York Harbor Healthcare System, 423 E. 23(rd) St., New York, NY 10010, USA; Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34(th) St., New York, NY 10016, USA; Research Service, VA New York Harbor Healthcare System, 423 E. 23(rd) St., New York, NY 10010, USA.
| | - Samantha P Martin
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34(th) St., New York, NY 10016, USA; Research Service, VA New York Harbor Healthcare System, 423 E. 23(rd) St., New York, NY 10010, USA.
| | - Richard Hardstone
- Neuroscience Institute, New York University Langone Health, 550 1st Ave., New York, NY 10016, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA.
| | - Danny M Tam
- Division of Psychology, Mental Health Service, VA New York Harbor Healthcare System, 423 E. 23(rd) St., New York, NY 10010, USA.
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34(th) St., New York, NY 10016, USA; Neuroscience Institute, New York University Langone Health, 550 1st Ave., New York, NY 10016, USA.
| | - Kimford J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, Palo Alto, CA 94304, USA.
| |
Collapse
|
4
|
Lozano-García A, Catalán-Aguilar J, Tormos-Pons P, Hampel KG, Villanueva V, Cano-López I, González-Bono E. Impact of Polytherapy on Memory Functioning in Patients With Drug-Resistant Epilepsy: The Role of Attention and Executive Functions. Arch Clin Neuropsychol 2024; 39:423-442. [PMID: 37987193 DOI: 10.1093/arclin/acad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE The aim was to examine the effect of polytherapy (i.e., the number of administered anti-seizure medications (ASMs)) on memory, and whether the interaction between the number of ASMs and attentional/executive functioning affect presurgical memory functioning and postsurgical memory changes in patients with drug-resistant epilepsy. METHODS Two studies were carried out. Study 1 consisted of a presurgical assessment of 125 adult patients, in which attention/executive function (EpiTrack screening tool) and memory were assessed (cross-sectional study). Of them, 72 patients underwent a second postsurgical evaluation, in which memory was assessed (Study 2). Patients were distributed into groups based on EpiTrack performance and number of ASMs. RESULTS The interaction between the number of ASMs and the attentional/executive functioning significantly affected presurgical memory, with patients with impaired EpiTrack performance taking three-four ASMs having poorer scores than patients with intact EpiTrack performance taking three-four ASMs (for all, p < .0001). This interaction also affected postsurgical memory changes, with patients with impaired Epitrack performance taking three-four ASMs having higher postsurgical decline than those with intact Epitrack performance taking three-four ASMs (for all, p < .005). No differences were found in patients taking two ASMs. Furthermore, the number of ASMs was associated with presurgical memory performance and postsurgical memory changes only in patients with impaired EpiTrack performance (for all, p < .05). CONCLUSIONS Our findings underline the utility of EpiTrack, together with the clinical information on the number of prescribed ASMs, to corroborate the impact of polytherapy on memory and to optimize the prediction of postsurgical memory changes.
Collapse
Affiliation(s)
- Alejandro Lozano-García
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Department of Psychology, Universidad Europea de Valencia, Valencia, Spain
- Faculty of Health Sciences, Universidad Isabel I, Burgos, Spain
| | - Judit Catalán-Aguilar
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Paula Tormos-Pons
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Irene Cano-López
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| |
Collapse
|
5
|
Takahashi K, Fujikawa M, Ueno T, Ogawa M, Nakasato N, Maeda S. Network analysis of the relationship between social support and quality of life in patients with epilepsy. Epilepsy Behav 2023; 149:109504. [PMID: 37952414 DOI: 10.1016/j.yebeh.2023.109504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Identifying important types of social support for patients with epilepsy is valuable to construct an effective system for support in daily life. However, previous studies have been inconsistent in identifying the most important types of social support for better quality of life (QOL) due to the high correlations between the social support factors. The present study employed network visualization analysis to identify the relationships between QOL and types of social support. METHODS Two hundred and eighty-three patients with epilepsy (age range: 18 to 75 years) completed questionnaires of the Medical Outcomes Study Social Support Survey (MOS-SSS) and the Quality of Life in Epilepsy Inventory-31-Problems in the epilepsy monitoring unit at Tohoku University. The MOS-SSS was established to measure the four types of social support including emotional/informational support, tangible support, affectionate support, and positive social interaction. Our network visualization analysis represented the entire structure of the interrelationships between the four functions of social support and QOL. In addition, the relative importance of each function of social support were estimated by the centrality indices using three commonly used centrality indices: strength, betweenness, and closeness. RESULTS The visualized network showed that positive social interaction and emotional/informational support were directly associated with QOL, whereas tangible support and affectionate support were not. Positive social interaction had the highest value for all three centrality indices and affectionate support had the second highest. Therefore, positive social interaction had the strongest connection to the other functions of support. DISCUSSION Our network analysis and centrality indices findings showed that positive social interaction is the most important within the network of four types of social support and QOL. The emotional informational function is also important for directly improving QOL but is less related to the other functions. The affectionate function might be an indicator of whether a patient has a foundational relationship that leads to other functions of support. CONCLUSION These results showed the importance of increasing positive social interaction in the social environment of patients with epilepsy. Therefore, practitioners need to encourage patients with epilepsy to increase their positive social interactions such as doing something enjoyable with others or someone to associate for relaxation to ensure high QOL. Connections outside the epilepsy support are important, such as having fun regardless of epilepsy, rather than only providing emotional or tangible support for epilepsy.
Collapse
Affiliation(s)
- Kento Takahashi
- Graduate School of Education, Tohoku University, Sendai, Japan
| | - Mayu Fujikawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Takashi Ueno
- Faculty of Comprehensive Welfare, Tohoku Fukushi University, Sendai, Japan
| | - Maimi Ogawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunta Maeda
- Graduate School of Education, Tohoku University, Sendai, Japan
| |
Collapse
|
6
|
Monteagudo-Gimeno E, Sánchez-González R, Raduà-Castaño J, Fortea-González L, Boget-Llucià T, Carreño-Martínez M, Donaire-Pedraza A, Bargalló-Alabart N, Setoain-Perego X, Rumià-Arboix J, Bulbena-Vilarrasa A, Pintor-Pérez L. Association between depressive and anxious symptoms with cognitive function and quality of life in drug-resistant epilepsy. Heliyon 2023; 9:e20903. [PMID: 37886767 PMCID: PMC10597766 DOI: 10.1016/j.heliyon.2023.e20903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
•Depressive/anxious disorders and cognitive impairment are frequent comorbidities in epilepsy and have a more deleterious effect in DRE.•Studies concerning the relationship between anxiety and depression and cognitive performance in DRE are scarce.•Higher scores in HADS are associated with lower QOLIE-31 scores and might be considered as predictors of QOL in DRE.•A relationship between anxious and depressive symptoms -measured with HADS and SCL-90R- and cognition might not exist.•There remains an unexplored study area regarding this relationship which requires more attention to improve the assessment of DRE.
Collapse
Affiliation(s)
- E. Monteagudo-Gimeno
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Benito Menni Mental Health Care Complex, Sant Boi de Llobregat, Barcelona, Spain
| | - R. Sánchez-González
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J. Raduà-Castaño
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
- FIDMAG Research Foundation, Sant Boi de Llobregat, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - L. Fortea-González
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - T. Boget-Llucià
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - M. Carreño-Martínez
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A. Donaire-Pedraza
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - N. Bargalló-Alabart
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
- Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - X. Setoain-Perego
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - J. Rumià-Arboix
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A. Bulbena-Vilarrasa
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - L. Pintor-Pérez
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Consultation-Liaison Service, Department of Psychiatry, Institut de Neurociències, Universitat de Barcelona, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Shakhatreh L, Foster E, Siriratnam P, Neal A, Carney PW, Jackson GD, O'Brien TJ, Kwan P, Chen Z, Ademi Z. Impact of epilepsy surgery on quality of life: Systematic review and meta-analysis. Epilepsia 2023; 64:1709-1721. [PMID: 37157209 DOI: 10.1111/epi.17644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
Improved quality of life (QoL) is an important outcome goal following epilepsy surgery. This study aims to quantify change in QoL for adults with drug-resistant epilepsy (DRE) who undergo epilepsy surgery, and to explore clinicodemographic factors associated with these changes. We conducted a systematic review and meta-analysis using Medline, Embase, and Cochrane Central Register of Controlled Trials. All studies reporting pre- and post-epilepsy surgery QoL scores in adults with DRE via validated instruments were included. Meta-analysis assessed the postsurgery change in QoL. Meta-regression assessed the effect of postoperative seizure outcomes on postoperative QoL as well as change in pre- and postoperative QoL scores. A total of 3774 titles and abstracts were reviewed, and ultimately 16 studies, comprising 1182 unique patients, were included. Quality of Life in Epilepsy Inventory-31 item (QOLIE-31) meta-analysis included six studies, and QOLIE-89 meta-analysis included four studies. Postoperative change in raw score was 20.5 for QOLIE-31 (95% confidence interval [CI] = 10.9-30.1, I2 = 95.5) and 12.1 for QOLIE-89 (95% CI = 8.0-16.1, I2 = 55.0%). This corresponds to clinically meaningful QOL improvements. Meta-regression demonstrated a higher postoperative QOLIE-31 score as well as change in pre- and postoperative QOLIE-31 score among studies of cohorts with higher proportions of patients with favorable seizure outcomes. At an individual study level, preoperative absence of mood disorders, better preoperative cognition, fewer trials of antiseizure medications before surgery, high levels of conscientiousness and openness to experience at the baseline, engagement in paid employment before and after surgery, and not being on antidepressants following surgery were associated with improved postoperative QoL. This study demonstrates the potential for epilepsy surgery to provide clinically meaningful improvements in QoL, as well as identifies clinicodemographic factors associated with this outcome. Limitations include substantial heterogeneity between individual studies and high risk of bias.
Collapse
Affiliation(s)
- Lubna Shakhatreh
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Emma Foster
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Andrew Neal
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Patrick W Carney
- Neurology Department, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Terence J O'Brien
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Faculty of Pharmacy, Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
8
|
Catalán-Aguilar J, González-Bono E, Lozano-García A, Tormos-Pons P, Hampel KG, Villanueva V, Cano-López I. Stress phenotypes in epilepsy: impact on cognitive functioning and quality of life. Front Psychol 2023; 14:1100101. [PMID: 37388654 PMCID: PMC10300421 DOI: 10.3389/fpsyg.2023.1100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/22/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Drug-resistant epilepsy has been proposed as a chronic stress model. Stress can be measured in terms of chronicity (epilepsy duration) and intensity (comorbidities), with depression and anxiety among the most important comorbidities in epilepsy due to its prevalence and its relationship with cognitive functioning and quality of life. This study aims to establish phenotypes according to how patients face a stressful condition (epilepsy) and examine differences in cognition and quality of life depending on these phenotypes. We hypothesize that there will be an interrelationship between epilepsy duration and negative affectivity, and these variables will influence cognition and quality of life. Methods 170 patients (82 men and 88 women) underwent a neuropsychological evaluation in which trait anxiety, depression, attention and executive function, verbal and visual memory, language, emotional recognition, and quality of life were assessed. Hierarchical clustering was performed using z-scores for three variables: trait anxiety; depression; and epilepsy duration. Results Three clusters were found: vulnerable (high negative affectivity and short duration); resilient (moderate negative affectivity and long duration); and low-impact group (low negative affectivity and short duration). Results show that the vulnerable group had poorer cognitive functioning and quality of life than the other groups. Specifically, the vulnerable group had poorer scores than the low-impact group on verbal memory, visual confrontation naming, and quality of life (except seizure worry). Furthermore, resilient patients had better scores than the low-impact group on cognitive flexibility variables, but lower scores on some quality-of-life subscales (i.e., overall quality of life, emotional well-being, and energy). Finally, the vulnerable group had poorer scores than the resilient group in executive functioning, naming, and quality of life. Discussion These results suggest that dealing with stress in patients with epilepsy is related to cognitive performance and quality of life. These findings underline the relevance of considering comorbidities in epilepsy and may be useful for detecting vulnerable or resilient profiles as risk or protective factors for cognitive and quality of life decline.
Collapse
Affiliation(s)
- Judit Catalán-Aguilar
- Institut d’Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (Idocal)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Esperanza González-Bono
- Institut d’Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (Idocal)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Alejandro Lozano-García
- Institut d’Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (Idocal)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Paula Tormos-Pons
- Institut d’Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (Idocal)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Kevin G. Hampel
- Refractory Epilepsy Unit, Neurology Service Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Irene Cano-López
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
| |
Collapse
|
9
|
Cano-López I, Lozano-García A, Catalán-Aguilar J, Hampel KG, Villanueva V, González-Bono E. The relationship between memory and quality of life is mediated by trait anxiety in patients with temporal lobe epilepsy. Qual Life Res 2023; 32:739-747. [PMID: 36418526 DOI: 10.1007/s11136-022-03306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Memory deficits are very frequent in patients with drug-resistant epilepsy, but they predict a small proportion of variance of their quality of life (QOL) in previous studies, possibly due to the lack of consideration of mediating factors of this relationship. This study aimed to examine whether trait anxiety mediates the relationship between memory and QOL in this population, controlling the influence of demographic and seizure-related factors. METHODS In this cross-sectional study, 119 adults with drug-resistant temporal lobe epilepsy (TLE) underwent a neuropsychological evaluation, in which memory, anxiety, and QOL were assessed. RESULTS In the total sample, better delayed memory had an effect on better QOL indirectly through lower trait anxiety (B = 0.13, SE = 0.06, p = 0.04, abcs = 0.13; κ2 = 0.18; PMind = 0.76). Additionally, delayed memory has not a direct association with QOL (B = 0.04, SE = 0.09, p = 0.64, Cohen's f 2 = 0.005; PMdir = 0.24), and the total effect of delayed memory on QOL tended to reach statistical significance (B = 0.17, SE = 0.10, p = 0.08). The proposed mediation model yielded excellent fit (CFI = 1.00, RMSEA = 0.0001, SRMR = 0.009, and χ2 (1) = 0.50, p = 0.48) and explained 38% of the variance of QOL. CONCLUSION These findings suggest that trait anxiety is an important factor in understanding the relationship between memory and QOL in patients with TLE, considering the influence of demographic and seizure-related variables, and may have relevant implications for decision-making in this population.
Collapse
Affiliation(s)
- Irene Cano-López
- Faculty of Health Sciences, Valencian International University, C/Pintor Sorolla, 21, 46002, Valencia, Spain.
| | - Alejandro Lozano-García
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010, Valencia, Spain
| | - Judit Catalán-Aguilar
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010, Valencia, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit. Neurology Service. Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Bulevar Sur, S/N Carretera de Malilla, 46026, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit. Neurology Service. Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Bulevar Sur, S/N Carretera de Malilla, 46026, Valencia, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010, Valencia, Spain
| |
Collapse
|
10
|
Treiber JM, Bayley JC, Curry D. Minimally Invasive Destructive, Ablative, and Disconnective Epilepsy Surgery. JOURNAL OF PEDIATRIC EPILEPSY 2023. [DOI: 10.1055/s-0042-1760106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractConventional epilepsy surgery performed by microsurgical dissection typically requires large cranial working windows created with high-speed drills and lengthy incisions. In the past few decades, minimally invasive techniques have been developed with smaller incisions, comparable efficacy, shorter hospitalizations, and better safety profiles. These minimally invasive alternatives utilize stereotactic, ultrasonic, radiotherapeutic, and endoscopic techniques. Although not able to completely replace conventional surgery for all etiologies of epilepsy, these minimally invasive techniques have revolutionized modern epilepsy surgery and have been an invaluable asset to the neurosurgeon's repertoire. The endoscope has allowed for surgeons to have adequate visualization during resective and disconnective epilepsy surgeries using keyhole or miniature craniotomies. Modern stereotactic techniques such as laser interstitial thermal therapy and radiofrequency ablation can be used as viable alternatives for mesial temporal lobe epilepsy and can destroy lesional tissue deep areas without the approach-related morbidity of microsurgery such as with hypothalamic hamartomas. These stereotactic techniques do not preclude future surgery in the settings of treatment failure and have been used successfully after failed conventional surgery. Multiple ablation corridors can be performed in a single procedure that can be used for lesioning of large targets or to simplify treating multifocal epilepsies. These stereotactic techniques have even been used successfully to perform disconnective procedures such as hemispherotomies and corpus callosotomies. In patients unable to tolerate surgery, stereotactic radiosurgery is a minimally invasive option that can result in improved seizure control with minimal procedural risks. Advances in minimally invasive neurosurgery provide viable treatment options for drug-resistant epilepsy with quicker recovery, less injury to functional brain, and for patients that may otherwise not choose conventional surgery.
Collapse
Affiliation(s)
- Jeffrey M. Treiber
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - James C. Bayley
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Daniel Curry
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
| |
Collapse
|
11
|
Wang R, Zhu W, Liang G, Xu J, Guo J, Wang L. Animal models for epileptic foci localization, seizure detection, and prediction by electrical impedance tomography. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2022; 13:e1619. [PMID: 36093634 DOI: 10.1002/wcs.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
Surgical resection of lesions and closed-loop suppression are the two main treatment options for patients with refractory epilepsy whose symptoms cannot be managed with medicines. Unfortunately, failures in foci localization and seizure prediction are constraining these treatments. Electrical impedance tomography (EIT), sensitive to impedance changes caused by blood flow or cell swelling, is a potential new way to locate epileptic foci and predict seizures. Animal validation is a necessary research process before EIT can be used in clinical practice, but it is unclear which among the many animal epilepsy models is most suited to this task. The selection of an animal model of epilepsy that is similar to human seizures and can be adapted to EIT is important for the accuracy and reliability of EIT research results. This study provides an overview of the animal models of epilepsy that have been used in research on the use of EIT to locate the foci or predict seizures; discusses the advantages and disadvantages of these models regarding inducement by chemical convulsant and electrical stimulation; and finally proposes optimal animal models of epilepsy to obtain more convincing research results for foci localization and seizure prediction by EIT. The ultimate goal of this study is to facilitate the development of new treatments for patients with refractory epilepsy. This article is categorized under: Neuroscience > Clinical Neuroscience Psychology > Brain Function and Dysfunction.
Collapse
Affiliation(s)
- Rong Wang
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Wenjing Zhu
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Guohua Liang
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Jiaming Xu
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Jie Guo
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Lei Wang
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| |
Collapse
|
12
|
Yu T, Liu X, Sun L, Lv R, Wu J, Wang Q. Risk factors for Drug-resistant Epilepsy (DRE) and a nomogram model to predict DRE development in post-traumatic epilepsy patients. CNS Neurosci Ther 2022; 28:1557-1567. [PMID: 35822252 PMCID: PMC9437227 DOI: 10.1111/cns.13897] [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: 01/23/2022] [Revised: 05/22/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives To identify factors affecting the development of drug‐resistant epilepsy (DRE), and establish a reliable nomogram to predict DRE development in post‐traumatic epilepsy (PTE) patients. Methods This study conducted a retrospective clinical analysis in patients with PTE who visited the Epilepsy Center, Beijing Tiantan Hospital from January 2013 to December 2018. All participants were followed up for at least 3 years, and the development of DRE was assessed. Data from January 2013 to December 2017 were used as development dataset for model building. Those independent predictors of DRE were included in the final multivariable logistic regression, and a derived nomogram was built. Data from January 2018 to December 2018 were used as validation dataset for internal validation. Results Complete clinical information was available for 2830 PTE patients (development dataset: 2023; validation dataset: 807), of which 21.06% (n = 596) developed DRE. Among all parameters of interest including gender, age at PTE, family history, severity of traumatic brain injury (TBI), single or multiple injuries, lesion location, post‐TBI treatments, acute seizures, PTE latency, seizure type, status epilepticus (SE), and electroencephalogram (EEG) findings, four predictors showed independent effect on DRE, they were age at PTE, seizure type, SE, and EEG findings. A model incorporating these four variables was created, and a nomogram to calculate the probability of DRE using the coefficients of the model was developed. The C‐index of the predictive model and the validation was 0.662 and 0.690, respectively. The goodness‐of‐fit test indicated good calibration for model development and validation (p = 0.272, 0.572). Conclusions The proposed nomogram achieved significant potential for clinical utility in the prediction of DRE among PTE patients. The risk of DRE for individual PTE patients can be estimated by using this nomogram, and identified high‐risk patients might benefit from non‐pharmacological therapies at an early stage.
Collapse
Affiliation(s)
- Tingting Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lei Sun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ruijuan Lv
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianping Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| |
Collapse
|
13
|
Khalife MR, Scott RC, Hernan AE. Mechanisms for Cognitive Impairment in Epilepsy: Moving Beyond Seizures. Front Neurol 2022; 13:878991. [PMID: 35645970 PMCID: PMC9135108 DOI: 10.3389/fneur.2022.878991] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
There has been a major emphasis on defining the role of seizures in the causation of cognitive impairments like memory deficits in epilepsy. Here we focus on an alternative hypothesis behind these deficits, emphasizing the mechanisms of information processing underlying healthy cognition characterized as rate, temporal and population coding. We discuss the role of the underlying etiology of epilepsy in altering neural networks thereby leading to both the propensity for seizures and the associated cognitive impairments. In addition, we address potential treatments that can recover the network function in the context of a diseased brain, thereby improving both seizure and cognitive outcomes simultaneously. This review shows the importance of moving beyond seizures and approaching the deficits from a system-level perspective with the guidance of network neuroscience.
Collapse
Affiliation(s)
- Mohamed R. Khalife
- Division of Neuroscience, Nemours Children's Health, Wilmington, DE, United States
- Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Rod C. Scott
- Division of Neuroscience, Nemours Children's Health, Wilmington, DE, United States
- Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
- Institute of Child Health, Neurosciences Unit University College London, London, United Kingdom
| | - Amanda E. Hernan
- Division of Neuroscience, Nemours Children's Health, Wilmington, DE, United States
- Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| |
Collapse
|
14
|
Watson GDR, Afra P, Bartolini L, Graf DA, Kothare SV, McGoldrick P, Thomas BJ, Saxena AR, Tomycz LD, Wolf SM, Yan PZ, Hagen EC. A journey into the unknown: An ethnographic examination of drug-resistant epilepsy treatment and management in the United States. Epilepsy Behav 2021; 124:108319. [PMID: 34563807 DOI: 10.1016/j.yebeh.2021.108319] [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: 06/11/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022]
Abstract
Patients often recognize unmet needs that can improve patient-provider experiences in disease treatment management. These needs are rarely captured and may be hard to quantify in difficult-to-treat disease states such as drug-resistant epilepsy (DRE). To further understand challenges living with and managing DRE, a team of medical anthropologists conducted ethnographic field assessments with patients to qualitatively understand their experience with DRE across the United States. In addition, healthcare provider assessments were conducted in community clinics and Comprehensive Epilepsy Centers to further uncover patient-provider treatment gaps. We identified four distinct stages of the treatment and management journey defined by patients' perceived control over their epilepsy: Gripped in the Panic Zone, Diligently Tracking to Plan, Riding a Rollercoaster in the Dark, and Reframing Priorities to Redefine Treatment Success. We found that patients sought resources to streamline communication with their care team, enhanced education on treatment options beyond medications, and long-term resources to protect against a decline in control over managing their epilepsy once drug-resistant. Likewise, treatment management optimization strategies are provided to improve current DRE standard of care with respect to identified patient-provider gaps. These include the use of digital disease management tools, standardizing neuropsychiatrists into patients' initial care team, and introducing surgical and non-pharmacological treatment options upon epilepsy and DRE diagnoses, respectively. This ethnographic study uncovers numerous patient-provider gaps, thereby presenting a conceptual framework to advance DRE treatment. Further Incentivization from professional societies and healthcare systems to support standardization of the treatment optimization strategies provided herein into clinical practice is needed.
Collapse
Affiliation(s)
| | - Pegah Afra
- Department of Neurology, Weill-Cornell Medicine, New York, NY 10065, USA
| | - Luca Bartolini
- Division of Pediatric Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel A Graf
- Department of Neurology, Geisinger Health System, Danville, PA 17822, USA
| | - Sanjeev V Kothare
- Department of Pediatric Neurology, Northwell Health, New York, NY 10011, USA
| | - Patricia McGoldrick
- Boston Children's Health Physicians and Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY 10595, USA
| | - Bethany J Thomas
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aneeta R Saxena
- Epilepsy Division, Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA, USA
| | | | - Steven M Wolf
- Boston Children's Health Physicians and Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY 10595, USA
| | - Peter Z Yan
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Eliza C Hagen
- LivaNova, Neuromodulation Unit, Houston, TX 77058, USA; Department of Neurology, Alameda County Medical Center, Oakland, CA 94602, USA
| |
Collapse
|
15
|
Lozano-García A, Hampel KG, Villanueva V, González-Bono E, Cano-López I. The number of anti-seizure medications mediates the relationship between cognitive performance and quality of life in temporal lobe epilepsy. Epilepsy Behav 2021; 115:107699. [PMID: 33412368 DOI: 10.1016/j.yebeh.2020.107699] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess whether cognitive performance predicts quality of life (QOL) in patients with drug-resistant temporal lobe epilepsy (TLE), using the Epitrack cognitive screening tool, while considering the mediating role of the number of anti-seizure medications (ASMs) and controlling for seizure-related, social, and emotional factors. METHODS Seventy-five adult patients with drug-resistant TLE (mean age = 39.76 years, SD = 11.66) underwent a presurgical neuropsychological assessment. MAIN OUTCOME MEASURES Cognitive performance (Epitrack), depression (BDI-II), trait anxiety (STAI); and QOL (QOLIE-31) were assessed. RESULTS Adjusting for seizure-related, social, and emotional factors, the Epitrack total score significantly contributed to QOL composite score, and energy and cognitive self-rating subscales. We found a significant indirect effect of the Epitrack total score on QOL composite score and seizure worry and social functioning subscales via the number of ASMs. CONCLUSION Our findings underline the relevance of cognitive functioning on QOL and the clinical utility of Epitrack to track cognitive side effects of ASMs and, consequently, to predict and manage QOL in this population.
Collapse
Affiliation(s)
- Alejandro Lozano-García
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026 Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026 Valencia, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Irene Cano-López
- Valencian International University, C/Pintor Sorolla, 21, 46002 Valencia, Spain.
| |
Collapse
|
16
|
Cortisol levels and seizures in adults with epilepsy: A systematic review. Neurosci Biobehav Rev 2019; 103:216-229. [PMID: 31129236 DOI: 10.1016/j.neubiorev.2019.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022]
Abstract
Stress has been suggested as a trigger factor for seizures in epilepsy patients, but little is known about cortisol levels, as indicators of stress, in adults with epilepsy. This systematic review summarizes the evidence on this topic. Following PRISMA guidelines, 38 articles were selected: 14 analyzing basal cortisol levels, eight examining antiepileptic drugs (AEDs) effects, 13 focused on seizure effects, and three examining stress. Higher basal cortisol levels were found in patients than in healthy people in studies with the most homogeneous samples (45% of 38 total studies). Despite heterogeneous results associated with AEDs, seizures were related to increases in cortisol levels in 77% of 38 total studies. The only study with acute stress administration found higher cortisol reactivity in epilepsy than in healthy controls. In studies using self-reported stress, high seizure frequency was related to increased cortisol levels and lower functional brain connectivity. Findings suggest that epilepsy could be considered a chronic stress model. The potential sensitizing role of accumulative seizures and issues for future research are discussed.
Collapse
|
17
|
Giovagnoli AR, Paterlini C, Meneses RF, Martins da Silva A. Spirituality and quality of life in epilepsy and other chronic neurological disorders. Epilepsy Behav 2019; 93:94-101. [PMID: 30851485 DOI: 10.1016/j.yebeh.2019.01.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/17/2019] [Accepted: 01/27/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE The patients with neurological disorders often report a different quality of life (QoL), which is in part explained by clinical-pathological or psychosocial variables. This study evaluated spirituality in patients with chronic brain pathologies, aiming to clarify its specificity and position to a multidimensional model of QoL. METHODS A hundred and ninety-nine adult patients with epilepsy (E) (n = 88), mild cognitive impairment (MCI) (n = 32), ischemic vascular disorders (n = 29), tumors (n = 28), or multiple sclerosis (MS) (n = 22), and 66 healthy subjects were assessed using the World Health Organization Quality of Life (WHOQoL) 100, Spiritual, Religious and Personal Beliefs (SRPB), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) for the QoL, spirituality, depression, and anxiety. The Multiple Ability Self-Report Questionnaire (MASQ) and neuropsychological tests evaluated the cognitive functions. RESULTS Factor analysis of the SRPB, STAI, and BDI scores yielded four factors: Personal Meaning, Inner Freedom, Awe and Openness, and Mood. Quality of life and spirituality were very similar between the patient groups. In comparison with the controls, all of the patients showed worse QoL, spirituality, mood, and lexical-memory abilities, and the patients with MCI and brain vascular disorders (BVD) also revealed worse cognitive impairments. Trait anxiety, self-rated health, age, and the SRPB Inner independence and Hope and optimism facets predicted the patients' WHOQoL 100 total score; the spiritual, affective, and socioeconomic variables predicted many QoL domains, but diagnosis only affected the Physical domain. Anxiety, self-rated health, Hope and optimism, and Personal beliefs predicted the controls' WHOQoL 100 total score. CONCLUSIONS Spirituality, as marked by the meaning of self, inner independence, and transcendence, is distinct from mood. It cooperates, together with the affective states, to determine the QoL of the patients with chronic brain pathologies whereas diagnosis has a limited impact. These findings support a multidimensional cross-disease model for the QoL in neurological disorders.
Collapse
Affiliation(s)
- Anna Rita Giovagnoli
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
| | - Chiara Paterlini
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | | |
Collapse
|