1
|
Cerulli Irelli E, Borioni MS, Morano A, Mazzeo A, Moro P, Orlando B, Salamone EM, Giordano L, Petrungaro A, Toccaceli Blasi M, Giallonardo AT, Canevelli M, Di Bonaventura C. Frailty as a comprehensive health measure beyond seizure control in patients with epilepsy: A cross-sectional study. Epilepsia 2024; 65:1658-1667. [PMID: 38536086 DOI: 10.1111/epi.17964] [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: 12/28/2023] [Revised: 02/12/2024] [Accepted: 03/11/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Due to the high clinical heterogeneity of epilepsy, there is a critical need for novel metrics aimed at capturing its biological and phenotypic complexity. Frailty is increasingly recognized in various medical disciplines as a useful construct to understand differences in susceptibility to adverse outcomes. Here, we develop a frailty index (FI) for patients with epilepsy (PwE) and explore its association with demographic and clinical features. METHODS In this cross-sectional study, we consecutively enrolled 153 PwE from an outpatient epilepsy clinic. Participants were assessed for various health deficits to calculate the FI. Associations between FI and demographic/clinical features, antiseizure medications (ASMs), and patient-reported outcomes were analyzed using general linear models and Spearman correlation. RESULTS The median age at the time of study visit was 47 years (interquartile range = 33-60), and 89 (58.2%) patients were females. Multiple linear regression revealed that the developed 33-item FI showed an independent association with age, female sex, higher body mass index, family history of epilepsy, intellectual disability, and the number of ASMs used. A robust analysis of covariance showed higher FI levels in patients using cytochrome P450 3A4-inducer ASMs. We found a moderate positive correlation between FI and psychological distress, lower quality of life, and physical frailty, measured by the Hospital Anxiety and Depression Scale, Quality of Life in Epilepsy Inventory-10, and handgrip strength, respectively. Finally, a weak association was observed between higher FI scores and an increased number of epileptic falls. SIGNIFICANCE This study highlights the significance of frailty as a comprehensive health measure in epilepsy. It suggests that frailty in this specific population is not only a manifestation of aging but is inherently linked to epilepsy and treatment-related factors. Future research is warranted to validate and refine the FI in diverse epilepsy populations and investigate its impact on specific adverse outcomes in longitudinal studies.
Collapse
Affiliation(s)
| | - Maria S Borioni
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Adolfo Mazzeo
- Institute of Research and Medical Care Neuromed, Pozzilli, Italy
| | | | - Biagio Orlando
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Luca Giordano
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Alessio Petrungaro
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- Neurorehabilitation Unit, IRCCS Santa Maria Nascente, Don Carlo Gnocchi Foundation, Milan, Italy
| | | | | | - Marco Canevelli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- Policlinico Umberto I, Rome, Italy
| |
Collapse
|
2
|
Szałwińska K, Cyuńczyk M, Kochanowicz J, Witkowska AM. Dietary and lifestyle behavior in adults with epilepsy needs improvement: a case-control study from northeastern Poland. Nutr J 2021; 20:62. [PMID: 34187474 PMCID: PMC8243538 DOI: 10.1186/s12937-021-00704-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/13/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Several factors predispose individuals with epilepsy to chronic diseases. Among them, nutrition and lifestyle factors have not been sufficiently studied. Therefore, the aim of this study was to evaluate patients with epilepsy in terms of diet, body composition and physical activity compared to healthy sex- and age-matched subjects to investigate whether there are risk factors for nutritional deficiencies and risk factors for the development of metabolic diseases. METHODS The case-control study involved 60 epileptic male and female volunteers and 70 healthy controls matched according to age and sex. Medical information was collected during the study, and a detailed questionnaire regarding eating and lifestyle habits was conducted. Physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ). Nutritional status was assessed by bioelectric impedance. Venous blood samples were taken for lipid and 25-hydroxyvitamin D3 (25(OH)D3) analyses. RESULTS A tendency toward an increase in LDL cholesterol was found in the individuals with epilepsy. Significantly higher body fat and insignificantly higher visceral fat were found in epileptic men than in healthy men. In epileptic women, a tendency toward a lower lean body mass was found. Patients with epilepsy were more sedentary, consumed less cottage cheese, fruit, pulses, nuts and seeds, vitamin C and potassium, and consumed more sugar-sweetened soda, fat and sodium than healthy people. On a positive note, individuals with epilepsy consumed less coffee and alcoholic beverages. More than 80% of the epileptic volunteers had diets that were low in folic acid, vitamin D and calcium, but a similar tendency was observed in the healthy volunteers. A higher percentage of the patients with epilepsy had diets that were low in niacin, vitamin C and potassium than the control group (25% vs. 7, 50% vs. 31% and 73 vs. 56%, respectively). A significantly lower serum concentration of 25(OH)D3 was observed in epileptic individuals and was found to be positively modulated by physical activity. CONCLUSIONS The results indicate that several behavior-related habits, which may predispose epileptic people to cardiovascular disease, need to be improved. For this reason, patients with epilepsy should be provided with more comprehensive medical care, including advice on nutrition and physical activity.
Collapse
Affiliation(s)
- Kamila Szałwińska
- Department of Food Biotechnology, Medical University of Białystok, Białystok, Poland
| | - Monika Cyuńczyk
- Department of Food Biotechnology, Medical University of Białystok, Białystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Anna M Witkowska
- Department of Food Biotechnology, Medical University of Białystok, Białystok, Poland.
| |
Collapse
|
3
|
Hsu CY, Cheng CY, Lee JD, Lee M, Ovbiagele B. Effects of long-term anti-seizure medication monotherapy on all-cause death in patients with post-stroke epilepsy: a nationwide population-based study in Taiwan. BMC Neurol 2021; 21:226. [PMID: 34154568 PMCID: PMC8215791 DOI: 10.1186/s12883-021-02241-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/10/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aim to compare the effect of long-term anti-seizure medication (ASM) monotherapy on the risk of death and new ischemic stroke in patients with post-stroke epilepsy (PSE). PATIENTS AND METHODS We identified all hospitalized patients (≥ 20 years) with a primary diagnosis of ischemic or hemorrhagic stroke from 2001 to 2012 using the National Health Insurance Research Database in Taiwan. The PSE cohort were defined as the stroke patients (1) who had no epilepsy and no ASMs use before the index stroke, and (2) who had epilepsy and ASMs use after 14 days from the stroke onset. The patients with PSE receiving ASM monotherapy were enrolled and were categorized into phenytoin, valproic acid, carbamazepine, and new ASM groups. We employed the Cox regression model to estimate the unadjusted and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) of death and new ischemic stroke within 5 years across all groups, using the new ASM group as the reference. RESULTS Of 6962 patients with PSE using ASM monotherapy, 3917 (56 %) were on phenytoin, 1623 (23 %) on valproic acid, 457 (7 %) on carbamazepine, and 965 (14 %) on new ASMs. After adjusting for confounders, compared with new ASM users, phenytoin users had a higher risk of death in 5 years (HR: 1.64; 95 % CI: 1.06-2.55). On the other hand, all ASM groups showed a similar risk of new ischemic stroke in 5 years. CONCLUSIONS Among patients with PSE on first-line monotherapy, compared to new ASMs, use of phenytoin was associated with a higher risk of death in 5 years.
Collapse
Affiliation(s)
- Chia-Yu Hsu
- Departments of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Yu Cheng
- Departments of Neurosurgery, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jiann-Der Lee
- Departments of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng Lee
- Departments of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, California, San Francisco, USA
| |
Collapse
|
4
|
Dong Z, Guo Q, Sun L, Li F, Zhao A, Liu J, Qu P, Zhu Q, Xiao C, Niu F, Liang S. Serum lipoprotein and RBC rigidity index to predict cerebral infarction in patients with carotid artery stenosis. J Clin Lab Anal 2017; 32:e22356. [PMID: 29130563 DOI: 10.1002/jcla.22356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/21/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study aims to determine the risk factors and to predict the occurrence of cerebral infarction in patients with carotid artery stenosis. METHODS Two hundred and one subjects with carotid artery stenosis were retrospectively selected from Jinshan Branch of Shanghai Sixth People's Hospital, 115 cases of which with cerebral infarction and 86 without it. Clinical tests were performed including coagulation indices, fasting glucose, serum lipid, and blood rheology. Logistic regression analyses were used to identify the risk factors. Regression model was established, and receiver operating characteristic (ROC) curve was applied to analyze its diagnostic value. RESULTS Our data indicated that apolipoprotein AI (OR = 0.051, 95% CI: 0.009-0.295), lipoprotein (a) (OR = 1.003, 95% CI: 1.001-1.005), and RBC rigidity index (OR = 0.383, 95% CI: 0.209-0.702) were independent risk factors. Area under the curve (AUC) of the regression model = 0.78, with the sensitivity of 73.9% (95% CI: 64.9%-81.7%) and specificity of 69.2% (95% CI: 52.4%-83.0%). Prediction probability was determined while logistic regression score >0.748 defaulted as high-risk status. High-risk ratios were 80% in progressive cerebral infarction and 72% in nonprogressive cerebral infarction (P > .05), respectively, while significant differences were found when both compared with controls (P < .001). CONCLUSIONS We show herein that the regression model based on apolipoprotein AI, lipoprotein (a), and RBC IR is a promising tool to predict the occurrence of cerebral infarction in patients with carotid artery stenosis. However, identification of novel diagnostic markers for progressive cerebral infarction is still necessary.
Collapse
Affiliation(s)
- Zhiwu Dong
- Department of Laboratory Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Qiang Guo
- Department of Ultrasound Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Li Sun
- Department of Laboratory Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Feifei Li
- Department of Laboratory Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Aihong Zhao
- Department of Laboratory Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Jingfan Liu
- Department of Laboratory Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Peipei Qu
- Department of Laboratory Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Qinghua Zhu
- Department of Laboratory Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Chunhai Xiao
- Department of Laboratory Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Fusheng Niu
- Department of Neurology, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Shuang Liang
- Department of Laboratory Medicine, Jinshan Branch of Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|