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Kwon CS, Rafati A, Gandy M, Scott A, Newton CR, Jette N. Multipsychiatric Comorbidity in People With Epilepsy Compared With People Without Epilepsy: A Systematic Review and Meta-analysis. Neurology 2024; 103:e209622. [PMID: 39008805 DOI: 10.1212/wnl.0000000000209622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Persons with epilepsy (PwE) have a higher risk of developing psychiatric comorbidities compared with the general population. There is limited knowledge about the prevalence of multiple psychiatric conditions in PwE. We summarize the current evidence on the prevalence of multipsychiatric comorbidities in PwE compared with persons without epilepsy. METHODS A systematic review of multipsychiatric comorbidities in PwE compared with persons without epilepsy was performed, and the results were reported using the Preferred Reporting Items of Systematic Reviews and Meta-analyses reporting standards. The search was conducted from January 1945 to June 2023 in Ovid MEDLINE. Embase, and PsycINFO, using the search terms related to "epilepsy," "psychiatric comorbidity," and "multimorbidity," combined with psychiatric disorders. Abstracts were reviewed in duplicate, and data were independently extracted using standard proforma. Data describing multipsychiatric comorbidities in PwE compared with persons without epilepsy were recorded. Descriptive statistics and, when feasible, meta-analyses are presented. The risk of bias of the studies was assessed using the Newcastle-Ottawa Scale and the International League Against Epilepsy tool. RESULTS A total of 12,841 records were identified from the systematic database search, and 15 studies met the eligibility criteria. All included studies were deemed high-quality in risk of bias according to both tools. The prevalence of multipsychiatric comorbidity was greater in persons with compared with those without epilepsy. The pooled prevalence of concomitant depression and anxiety disorder in PwE in 2 population-based studies was 15 of 163 (9.2%), which was significantly higher than 250 of 10,551 (2.4%) in patients without epilepsy (odds ratio [OR] 3.7, 95% CI 2.1-6.5, p-value <0.001, I2 = 0%, Cochran Q p-value for heterogeneity = 0.84). In 2 hospital-based studies, the prevalence of concomitant depression and attention-deficit/hyperactivity disorder in PwE (14/97, 14.4%) was significantly higher than in patients without epilepsy (5/126, 3.9%), with an OR 5.2 (95% CI 1.8-15.0, p-value = 0.002, I2 = 0%, Cochran Q p-value for heterogeneity = 0.79). DISCUSSION PwE experience elevated levels of multipsychiatric comorbidity compared with those without epilepsy. However, very few studies have empirically evaluated the extent of multipsychiatric comorbidity in PwE compared with persons without epilepsy nor their associations and consequences to prognosis in PwE.
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Affiliation(s)
- Churl-Su Kwon
- From the Departments of Neurology (C.-S.K.), Epidemiology (C.-S.K.), and Neurosurgery (C.-S.K.), Columbia University Irving Medical Center, New York; the Gertrude H. Sergievsky Center (C.-S.K.), New York, NY; School of Medicine (A.R.), Iran University of Medical Sciences, Tehran, Iran; Department of Psychiatry (C.-S.K., C.R.N.), University of Oxford, United Kingdom; School of Psychological Sciences (M.G., A.S.), Macquarie University, Sydney, Australia; and Department of Neurology (N.J.), University of Calgary, Alberta, Canada
| | - Ali Rafati
- From the Departments of Neurology (C.-S.K.), Epidemiology (C.-S.K.), and Neurosurgery (C.-S.K.), Columbia University Irving Medical Center, New York; the Gertrude H. Sergievsky Center (C.-S.K.), New York, NY; School of Medicine (A.R.), Iran University of Medical Sciences, Tehran, Iran; Department of Psychiatry (C.-S.K., C.R.N.), University of Oxford, United Kingdom; School of Psychological Sciences (M.G., A.S.), Macquarie University, Sydney, Australia; and Department of Neurology (N.J.), University of Calgary, Alberta, Canada
| | - Milena Gandy
- From the Departments of Neurology (C.-S.K.), Epidemiology (C.-S.K.), and Neurosurgery (C.-S.K.), Columbia University Irving Medical Center, New York; the Gertrude H. Sergievsky Center (C.-S.K.), New York, NY; School of Medicine (A.R.), Iran University of Medical Sciences, Tehran, Iran; Department of Psychiatry (C.-S.K., C.R.N.), University of Oxford, United Kingdom; School of Psychological Sciences (M.G., A.S.), Macquarie University, Sydney, Australia; and Department of Neurology (N.J.), University of Calgary, Alberta, Canada
| | - Amelia Scott
- From the Departments of Neurology (C.-S.K.), Epidemiology (C.-S.K.), and Neurosurgery (C.-S.K.), Columbia University Irving Medical Center, New York; the Gertrude H. Sergievsky Center (C.-S.K.), New York, NY; School of Medicine (A.R.), Iran University of Medical Sciences, Tehran, Iran; Department of Psychiatry (C.-S.K., C.R.N.), University of Oxford, United Kingdom; School of Psychological Sciences (M.G., A.S.), Macquarie University, Sydney, Australia; and Department of Neurology (N.J.), University of Calgary, Alberta, Canada
| | - Charles R Newton
- From the Departments of Neurology (C.-S.K.), Epidemiology (C.-S.K.), and Neurosurgery (C.-S.K.), Columbia University Irving Medical Center, New York; the Gertrude H. Sergievsky Center (C.-S.K.), New York, NY; School of Medicine (A.R.), Iran University of Medical Sciences, Tehran, Iran; Department of Psychiatry (C.-S.K., C.R.N.), University of Oxford, United Kingdom; School of Psychological Sciences (M.G., A.S.), Macquarie University, Sydney, Australia; and Department of Neurology (N.J.), University of Calgary, Alberta, Canada
| | - Nathalie Jette
- From the Departments of Neurology (C.-S.K.), Epidemiology (C.-S.K.), and Neurosurgery (C.-S.K.), Columbia University Irving Medical Center, New York; the Gertrude H. Sergievsky Center (C.-S.K.), New York, NY; School of Medicine (A.R.), Iran University of Medical Sciences, Tehran, Iran; Department of Psychiatry (C.-S.K., C.R.N.), University of Oxford, United Kingdom; School of Psychological Sciences (M.G., A.S.), Macquarie University, Sydney, Australia; and Department of Neurology (N.J.), University of Calgary, Alberta, Canada
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Hajji EB, Traore B, Hassoune S, Khoubila A, Bellakhdar S, Rafai MA, Lakhdar A. Prevalence and associated factors of psychiatric comorbidities in epilepsy in the Casablanca-Settat region of Morocco: A cross-sectional study. Epilepsia Open 2024; 9:1321-1332. [PMID: 38738817 PMCID: PMC11296105 DOI: 10.1002/epi4.12958] [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: 12/19/2023] [Revised: 03/29/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVE To determine the estimated prevalence of anxiety, depression, and anxiety-depression syndrome (ADS) and to identify the associated factors in Moroccan people with epilepsy (PWE). METHOD A cross-sectional study was conducted among adult PWE (June 2021-December 2022) in the Casablanca-Settat region. PWE were interviewed by completing a questionnaire collecting sociodemographic and clinical data. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Out of 21 points, a score ≥8 is in favor of considerable anxiety/depression symptoms and a sum of the two scores ≥15 indicates the presence of ADS. Data were analyzed using Statistical Package for Social Sciences (SPSS) 21.0. p-values ≤0.05 were considered statistically significant and logistic regression was performed to determine the associated factors. RESULTS Among 294 PWE, the median age was 39 years (interquartile range [IQR]: 25.75-54.00). The median anxiety, depression, and ADS scores were 8 (IQR: 5.00-10.00), 7 (IQR: 4.00-10.00), and 15 (IQR: 10.00-20.00), respectively. Anxiety, depression, and ADS were revealed in 51.4%, 44.9%, and 51.0% of PWE, respectively. Depression was the only predictor for anxiety (aOR = 24.20; 95%CI: 12.45-47.01). Antiseizure polytherapy (aOR = 3.35; 95%CI: 1.72-6.54) and anxiety (aOR = 24.04; 95%CI: 12.12-47.67) were the factors associated with depression. The risk of ADS was increased by female gender (aOR = 2.83; 95%CI: 1.68-4.78), antiseizure polytherapy (aOR = 2.75; 95%CI: 1.62-4.65), structural epilepsy (aOR = 1.73; 95%CI: 1.01-2.94), and the presence of concomitant conditions with epilepsy (aOR = 1.96; 95%CI: 1.16-3.31). SIGNIFICANCE Our study reports high psychiatric comorbidity prevalence in epilepsy, which supports the bidirectional link hypothesis. Associated factors found are important in the prognosis and prevention. PLAIN LANGUAGE SUMMARY The neural mechanisms underlying epilepsy tend to expose PWE to psychiatric disorders. Our study aims to quantify the rate of psychiatric comorbidities and their predictive factors in Moroccan PWE. The estimated prevalences of significant symptoms of anxiety, depression, and ADS were 51.4%, 44.9%, and 51.0%, respectively. Depression was the predictor of anxiety. Antiseizure polymedication and anxiety were the associated factors with depression. The risk of SAD was increased by female gender, antiseizure polymedication, structural epilepsy, and concomitant diseases with epilepsy. Our results are important for considering the psychiatric aspect of PWE and improving their care and quality of life.
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Affiliation(s)
- El Bachir Hajji
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and PharmacyHassan II UniversityCasablancaMorocco
| | - Boubacar Traore
- Laboratory of Epidemiology, Faculty of Medicine and PharmacyHassan II UniversityCasablancaMorocco
- Direction de la Pharmacie et du Médicament (DPM)BamakoMali
| | - Samira Hassoune
- Laboratory of Epidemiology, Faculty of Medicine and PharmacyHassan II UniversityCasablancaMorocco
- Laboratory of Cellular and Molecular Pathology, Team “Epidemiology and Histology of Chronic and Cancerous Diseases”, Faculty of Medicine and PharmacyHassan II UniversityCasablancaMorocco
| | - Adil Khoubila
- Clinical Neurosciences and Mental Health Research LaboratoryUniversity Hassan IICasablancaMorocco
- University Psychiatric Centre, University Hospital Ibn RochdCasablancaMorocco
| | - Salma Bellakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and PharmacyHassan II UniversityCasablancaMorocco
- Department of NeurologyIBN ROCHD University HospitalCasablancaMorocco
| | - Mohammed Abdoh Rafai
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and PharmacyHassan II UniversityCasablancaMorocco
- Department of NeurologyIBN ROCHD University HospitalCasablancaMorocco
| | - Abdelhakim Lakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and PharmacyHassan II UniversityCasablancaMorocco
- Department of NeurosurgeryIBN ROCHD University HospitalCasablancaMorocco
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Koroukian SM, Fein HL, Vu L, Bensken WP, Schiltz NK, Sajatovic M, Ghearing GR, Warner DF. Excess prevalence of preexisting chronic conditions in older adults with incident epilepsy. Epilepsia 2024; 65:2354-2367. [PMID: 38837227 PMCID: PMC11465140 DOI: 10.1111/epi.18032] [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: 12/02/2023] [Revised: 05/17/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Prior studies have examined chronic conditions in older adults with prevalent epilepsy, but rarely among those with incident epilepsy. Identifying the chronic conditions with which older adults present at epilepsy incidence assists with the evaluation of disease burden in this patient population and informs coordinated care development. The aim of this study was to identify preexisting chronic conditions with excess prevalence in older adults with incident epilepsy compared to those without. METHODS Using a random sample of 4 999 999 fee-for-service Medicare beneficiaries aged >65 years, we conducted a retrospective cohort study of epilepsy incidence in 2019. Non-Hispanic Black and Hispanic beneficiaries were oversampled. We identified preexisting chronic conditions from the 2016-2018 Medicare Beneficiary Summary Files and compared chronic condition prevalence between Medicare beneficiaries with and without incident epilepsy in 2019. We characterized variations in preexisting excess chronic condition prevalence by age, sex, and race/ethnicity, adjusting for the racial/ethnic oversampling. RESULTS We observed excess prevalence of most preexisting chronic conditions in beneficiaries with incident epilepsy (n = 20 545, weighted n = 19 631). For stroke, for example, the adjusted prevalence rate ratio (APRR) was 4.82 (99% CI:4.60, 5.04), meaning that, compared to those without epilepsy, beneficiaries with incident epilepsy in 2019 had 4.82 times the stroke prevalence. Similarly, beneficiaries with incident epilepsy had a higher prevalence rate for preexisting neurological conditions (APRR = 3.17, 99% CI = 3.08-3.27), substance use disorders (APRR = 3.00, 99% CI = 2.81-3.19), and psychiatric disorders (APRR = 1.98, 99% CI = 1.94-2.01). For most documented chronic conditions, excess prevalence among beneficiaries with incident epilepsy in 2019 was larger for younger age groups compared to older age groups, and for Hispanic beneficiaries compared to both non-Hispanic White and non-Hispanic Black beneficiaries. SIGNIFICANCE Compared to epilepsy-free Medicare beneficiaries, those with incident epilepsy in 2019 had a higher prevalence of most preexisting chronic conditions. Our findings highlight the importance of health promotion and prevention, multidisciplinary care, and elucidating shared pathophysiology to identify opportunities for prevention.
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Affiliation(s)
- Siran M. Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Hannah L. Fein
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Long Vu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Wyatt P. Bensken
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nicholas K. Schiltz
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Martha Sajatovic
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Gena R. Ghearing
- Department of Neurology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - David F. Warner
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Family & Demographic Research, Bowling Green State University, Bowling Green, Ohio, USA
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Bush KJ, Cullen E, Mills S, Chin RFM, Thomas RH, Kingston A, Pickrell WO, Ramsay SE. Assessing the extent and determinants of socioeconomic inequalities in epilepsy in the UK: a systematic review and meta-analysis of evidence. Lancet Public Health 2024; 9:e614-e628. [PMID: 39095136 DOI: 10.1016/s2468-2667(24)00132-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Socioeconomic inequalities in epilepsy incidence and its adverse outcomes are documented internationally, yet the extent of inequalities and factors influencing the association can differ between countries. A UK public health response to epilepsy, which prevents epilepsy without widening inequalities, is required. However, the data on UK epilepsy inequalities have not been synthesised in a review and the underlying determinants are unknown. METHODS In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143). FINDINGS We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16-1·56]; I2=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I2=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19-1·57]; I2=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes. INTERPRETATION Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes. FUNDING Epilepsy Research Institute UK.
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Affiliation(s)
- Kathryn J Bush
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Emer Cullen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susanna Mills
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, Department of Child Life and Health and the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - William Owen Pickrell
- Swansea University Medical School, Swansea University, Swansea, UK; Neurology Department, Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Yasin M, Licchetta L, Khan N, Ullah I, Jan Z, Dawood M, Ahmed AN, Azeem A, Minardi R, Carelli V, Saleha S. Genetic heterogeneity in epilepsy and comorbidities: insights from Pakistani families. BMC Neurol 2024; 24:172. [PMID: 38783254 PMCID: PMC11112905 DOI: 10.1186/s12883-024-03671-7] [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: 11/28/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Epilepsy, a challenging neurological condition, is often present with comorbidities that significantly impact diagnosis and management. In the Pakistani population, where financial limitations and geographical challenges hinder access to advanced diagnostic methods, understanding the genetic underpinnings of epilepsy and its associated conditions becomes crucial. METHODS This study investigated four distinct Pakistani families, each presenting with epilepsy and a spectrum of comorbidities, using a combination of whole exome sequencing (WES) and Sanger sequencing. The epileptic patients were prescribed multiple antiseizure medications (ASMs), yet their seizures persist, indicating the challenging nature of ASM-resistant epilepsy. RESULTS Identified genetic variants contributed to a diverse range of clinical phenotypes. In the family 1, which presented with epilepsy, developmental delay (DD), sleep disturbance, and aggressive behavior, a homozygous splice site variant, c.1339-6 C > T, in the COL18A1 gene was detected. The family 2 exhibited epilepsy, intellectual disability (ID), DD, and anxiety phenotypes, a homozygous missense variant, c.344T > A (p. Val115Glu), in the UFSP2 gene was identified. In family 3, which displayed epilepsy, ataxia, ID, DD, and speech impediment, a novel homozygous frameshift variant, c.1926_1941del (p. Tyr643MetfsX2), in the ZFYVE26 gene was found. Lastly, family 4 was presented with epilepsy, ID, DD, deafness, drooling, speech impediment, hypotonia, and a weak cry. A homozygous missense variant, c.1208 C > A (p. Ala403Glu), in the ATP13A2 gene was identified. CONCLUSION This study highlights the genetic heterogeneity in ASM-resistant epilepsy and comorbidities among Pakistani families, emphasizing the importance of genotype-phenotype correlation and the necessity for expanded genetic testing in complex clinical cases.
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Affiliation(s)
- Muhammad Yasin
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, 26000, Pakistan
| | - Laura Licchetta
- RCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Niamat Khan
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, 26000, Pakistan
| | - Irfan Ullah
- Department of Neurology, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, 25000, Pakistan
| | - Zakir Jan
- Department of Neurology, Pakistan Institute of Medical Science, Islamabad, 44000, Pakistan
| | - Muhammad Dawood
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, 26000, Pakistan
| | - Asif Naveed Ahmed
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, 26000, Pakistan
| | - Arfa Azeem
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, 26000, Pakistan
| | - Raffaella Minardi
- RCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Valerio Carelli
- RCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Shamim Saleha
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, 26000, Pakistan.
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Byrne GR, Shafran R, Whadcock K, Bennett SD. The Influence of Comorbidity and Perceived Complexity on Outcomes of Referrals to Children and Young Person Mental Health Services (UK): A Mixed Methods Vignette Study. Clin Child Psychol Psychiatry 2023; 28:1393-1407. [PMID: 36843314 DOI: 10.1177/13591045231155990] [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] [Indexed: 02/28/2023]
Abstract
Children and young people (CYP) with long-term physical conditions (LTCs) are four times more likely to develop mental health disorders yet many cannot access Children and Young People's Mental Health Services (CYPMHS) or evidence-based interventions. This study aimed to understand the reasons for this; presence of an LTC neurodevelopmental disorder, or service requirements. 79 CYP mental health practitioners were randomly assigned to read vignettes depicting a hypothetical referral letter for a child with a mental health condition alone (n = 27), mental health condition and LTC (n = 25), or mental health condition and neurodevelopmental disorder (Autism Spectrum Disorder-ASD) (n = 27), answering questions about their likelihood of accepting the referral and proposed treatment plan. There were no significant differences between accessing CYPMHS or being offered first line evidence-based interventions in those with a LTC or ASD compared to those without. However, additional perceived complexity was frequently provided as a reason for rejecting referrals and not offering evidence-based intervention, with clinicians' predicted success of intervention significantly lower for these CYP. Clinicians were significantly more likely to suggest adapting the intervention in the LTC and the ASD groups to account for additional perceived complexity. The research suggests a need for additional services for CYP with LTCs and those with neurodevelopmental disorders, as well as training/awareness for clinicians.
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Marshall AD, Leach JP, Mackay D, Heath CA. The impact of the COVID-19 pandemic on a cohort of adults with epilepsy. Seizure 2023; 111:191-195. [PMID: 37678077 DOI: 10.1016/j.seizure.2023.09.002] [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: 05/17/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess the direct and indirect impacts of the COVID-19 pandemic on adults with epilepsy in Glasgow. METHODS We used routinely collected data for a previously identified cohort of patients with epilepsy to evaluate access to scheduled and unscheduled care with quarterly rates of inpatient admissions, outpatient attendance and accident & emergency attendance calculated. Anti-seizure medication prescribing and persistence, incidence of anxiety and depression and deaths for a cohort of patients with epilepsy was evaluated prior to the pandemic in comparison to during the pandemic, from 2015 to 2021. RESULTS All-cause mortality and epilepsy related mortality showed a statistically significant reduction during the pandemic. Although overall rates of out-patient hospital attendance dropped during the early stages of the pandemic (and had not returned to pre-pandemic levels by the end of 2021) epilepsy-related services saw maintenance of patient contact as a result of a rapid adoption of telephone clinics. A significant decrease in overall mortality was observed in PWE during the pandemic compared to the pre-pandemic period. COVID-19 was the single commonest cause of death in PWE during the pandemic (61/453) and 160 patients (3.7%) had at least 1 admission to hospital for COVID-19. Anti-seizure medication (ASM) prescribing remained rates remained stable during the pandemic. During the pandemic an average of 38.8% of cohort patients were treated for depression and 16.3% for anxiety per quarter, 8.2% and 12.4% of whom had not been previously treated for these conditions respectively. CONCLUSION We have shown that during a national lockdown, in the context of a pandemic, mortality in patients with epilepsy has reduced, while out-patient services were delivered remotely, primarily via the telephone. The reasons for this remain unclear but suggest that some of the excess mortality in people with epilepsy may be potentially avoidable by changes in lifestyle.
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Affiliation(s)
- A D Marshall
- School of Health and Wellbeing, University of Glasgow, UK.
| | - J P Leach
- Department of Neurology, Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, UK
| | - D Mackay
- School of Health and Wellbeing, University of Glasgow, UK
| | - C A Heath
- Department of Neurology, Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, UK
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Guo X, Lin W, Zhong R, Han Y, Yu J, Yan K, Zhang X, Liang J. Factors related to the severity of obsessive-compulsive symptoms and their impact on suicide risk in epileptic patients. Epilepsy Behav 2023; 146:109362. [PMID: 37499582 DOI: 10.1016/j.yebeh.2023.109362] [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: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To explore relevant factors for the severity of obsessive-compulsive symptoms (OCSs) in adult epileptic patients and investigate whether the severity of OCSs is a mediator in the relationship between depressive/anxiety symptoms and suicide risk in epileptic patients. METHODS This was a cross-sectional study from a hospital in Northeast China. Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Neurological Disorders Depression Inventory for Epilepsy (NDDIE), Generalized Anxiety Disorder (GAD-7), and Nurses' Global Assessment of Suicide Risk (NGASR) were used to assess the severity of OCSs, depressive symptoms, anxiety symptoms, and suicide risk in epileptic patients, respectively. The independent factors of the severity of OCSs and their mediating effects in the relationship between depressive/anxiety symptoms and suicide risk were evaluated by regression analyses and mediator models, respectively. RESULTS NDDIE scores (β = 0.404, p < 0.001), GAD-7 scores (β = 0.247, p = 0.009), and polytherapy (β = 0.119, p = 0.032) were the independent factors of Y-BOCS scores. The Y-BOCS scores partially mediated the relationship between GAD-7 scores and NGASR scores (standardized coefficients of indirect effect = 0.109, Bootstrap 95% CI = 0.024 to 0.214). Still, they did not mediate the relationship between NDDIE scores and NGASR scores (standardized coefficients of indirect effect = 0.062, Bootstrap 95% CI = -0.024 to 0.169). CONCLUSIONS Depressive symptoms, anxiety symptoms, and polytherapy are independently associated with the severity of OCSs in epileptic patients. Depressive and anxiety symptoms mediate the effect of the severity of OCSs on suicide risk in epileptic patients completely.
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Affiliation(s)
- Xin Guo
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yujuan Han
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jieyang Yu
- Department of Pediatric Neurology, the First Hospital of Jilin University, Changchun, China
| | - Kangle Yan
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Jianmin Liang
- Department of Pediatric Neurology, the First Hospital of Jilin University, Changchun, China.
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Babunovska M, Jovanovski A, Boskovski B, Foteva M, Kuzmanovski I, Trencevska GK, Cvetkovska E. Fractures in people with epilepsy: A nationwide population-based cohort study. Epilepsia Open 2023; 8:1028-1037. [PMID: 37335272 PMCID: PMC10472370 DOI: 10.1002/epi4.12776] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the age, gender, and site-specific prevalence of fractures in people with epilepsy (PWE) and matched general population comparators in a nationwide study in North Macedonia between 2015 and 2018. METHODS PWE and matched controls were selected through a systematic search of the electronic National Health System (eNHS). We determined the period prevalence (PP) of all site-specific fractures. We also calculated gender and age-specific incidence rate ratios (IRR) for various fractures. Odds ratios (ORs) and risk ratios (RR) were estimated for the number and type of ASM as well as comorbid conditions. RESULTS Out of 13 818 prevalent epilepsy cases, 6383 (46.2%) were females, and 7435 (53.8%) were males. 109 PWE out of 1000 had at least one fracture during the study period and ~8 people out of 1000 in the general population. The most frequent sites in terms of PP both in PWE and controls, were fractures of the lower arm, hip and femur, and lower leg. Significant differences in PP for all fracture locations were observed between PWE and controls (P < 0.001). The noticeable differences of ∼100 times higher PP were observed for fractures of the skull and jaw in PWE. IRR of any fracture in PWE was 272.84/10 000 person-years; higher in the older age groups and among people who received >2 ASM. Fracture risk was increased with the use of >2 ASM (OR: 1.56; 95% CI: 1.32-1.84 and RR: RR: 1.32). The presence of comorbidities also increased fractures risk (OR: 1.24; 95% CI: 1.10-1.38). SIGNIFICANCE This population-based study depicts a higher fracture prevalence in PWE compared to the general population. A higher number of ASM and the presence of comorbidities increase the risk of fractures and targeted prevention might be needed in those subgroups of PWE.
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Affiliation(s)
- Marija Babunovska
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Aleksandar Jovanovski
- Clinic for Neurology, Early Rehabilitation and Complex Neurological TreatmentEvangelical ClinicsGelsenkirchenGermany
| | - Bojan Boskovski
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Marta Foteva
- University Clinic for Orthopedic SurgerySs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Igor Kuzmanovski
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Gordana Kiteva Trencevska
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Emilija Cvetkovska
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
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Albalawi RSA, Alanzi SMO, Alharthe AFH, Atawi SHS, Albalawi RMD, Alanazi HAS, Alsayed MSA, Zubair M. Quantitative Cross-Sectional Study About the Prevalence of Depression Among Epileptic Patients in Saudi Arabia. Cureus 2023; 15:e45491. [PMID: 37859888 PMCID: PMC10584377 DOI: 10.7759/cureus.45491] [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: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND There are high prevalence of mental health co-morbidities in people with epilepsy, with major depressive disorder being the most common among them. OBJECTIVE This study aims to investigate the prevalence of depression among epileptic patients in Saudi Arabia. We also explored some of the sociodemographic and clinical variables associated with depression in epilepsy. METHODS This was a cross-sectional analysis executed across the four geographical regions of Saudi Arabia and the sample size is calculated to be 358. Data collection was facilitated through a digital self-administered questionnaire, which consisted of three parts: patients' sociodemographic variables, clinical variables, and patient health questionnaire (PHQ-9) depression score. Data processing and analytical procedures are undertaken using the SPSS software. RESULTS Of the participants, 311 responded: 65.6% were females, and 34.4% were males. Approximately 50.5% had a confirmed epilepsy diagnosis and were included in the PHQ-9 depression score analysis. Notably, 84.7% manifested depressive symptoms, with the severe category being predominant at 84.7% and moderate at 3.8%. An intriguing observation was the heightened prevalence among the younger demographic (16 to 24 years), registering at 34.4%, a figure nearly 3% superior to older age brackets. CONCLUSION The majority of participants manifested depressive symptoms, with a significant association noted between medication quantity and depression prevalence in epilepsy. It is imperative to broaden the scope of research, encompassing varied methodologies and spanning multiple urban centers, to procure more robust and generalizable conclusions.
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Whitney DG, Xu T, Whibley D, Erickson SR. High cardiorespiratory disease burden following a fracture among adults with intellectual disabilities. Bone 2023; 172:116784. [PMID: 37121558 PMCID: PMC10360920 DOI: 10.1016/j.bone.2023.116784] [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: 03/13/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Adults with intellectual disabilities have a greater risk for fragility fractures that begin to accumulate early in the adult lifespan, which may contribute to accelerated health declines. The objective was to determine if fragility fractures were associated with an increased 2-year rate of cardiorespiratory diseases among adults with intellectual disabilities. METHOD This retrospective cohort study used nationwide administrative claims data from 01/01/2011-12/31/2016 from the Medicare fee-for-service database. 2-year incidence of cardiorespiratory diseases were compared between adults ≥18 years old with intellectual disabilities with (n = 6183) vs. without (n = 67,842) an incident fragility fracture after confounder adjustment using Cox regression. RESULTS Fracture at the vertebral column, hip, non-proximal femur, tibia/fibula, and multiple sites had an elevated hazard ratio (HR) compared to those with no fracture for pneumonia, respiratory failure, heart failure, and cerebrovascular disease (HR range, 1.15-2.09, all P < 0.05), while humerus and radius/ulna fracture were associated with an elevated HR for congestive heart failure and cerebrovascular disease (HR range, 1.38-1.72, all P < 0.05). CONCLUSIONS Fragility fractures were associated with an increased incidence of cardiorespiratory diseases among adults with intellectual disabilities.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.
| | - Tao Xu
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
| | - Steven R Erickson
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, USA
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Fan HC, Chiang KL, Chang KH, Chen CM, Tsai JD. Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges. Int J Mol Sci 2023; 24:ijms24065270. [PMID: 36982345 PMCID: PMC10049646 DOI: 10.3390/ijms24065270] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, Hungkuang University, Taichung 433, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- The iEGG and Animal Biotechnology Center, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
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13
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Thowfeek S, Kaul N, Nyulasi I, O'Brien TJ, Kwan P. Dietary intake and nutritional status of people with epilepsy: A systematic review. Epilepsy Behav 2023; 140:109090. [PMID: 36702056 DOI: 10.1016/j.yebeh.2023.109090] [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: 10/09/2022] [Revised: 12/16/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE In people with epilepsy achieving optimal dietary intake may be hampered by psychological and physical comorbidities associated with seizures, medication use, socioeconomic disadvantage and the use of therapeutic diets. This systematic review aimed to evaluate the reported dietary intake and nutritional status of children and adults with epilepsy. METHODS A systematic literature search was completed across Ovid MEDLINE, EMBASE and CINAHL (all from inception to 4 November 2021). We included studies that reported dietary intake in adults and children diagnosed with epilepsy compared with local reference ranges, control groups or general populations. Studies using interventions and therapeutic diets were excluded. Risk of bias was assessed using the Study Quality Assessment Tools by the National Heart, Lung and Blood Institute. A descriptive analysis was performed due to the heterogenous nature of the data. RESULTS The initial search returned 1214 articles. Full-text screening was completed for 98 studies and 19 studies met eligibility criteria and were included for extraction. These comprised of seven paediatric studies, eight adult studies and four studies that included both adult and paediatric cohorts. Sample size of cases in each study ranged from 17 to 3,220. Vitamin A, C, D and folate were the most frequently reported vitamins. Calcium, iron and zinc were the most commonly reported minerals. Most studies showed that people with epilepsy had poorer dietary intake and nutritional status compared with control groups or reference standards. CONCLUSION There were limited studies on dietary intake and nutritional status in people with epilepsy. Most available studies suggested poorer status compared to non-epilepsy controls. The development of a validated dietary assessment tool specifically for epilepsy cohorts would enable comparison of findings across studies, and aid with appropriately tailoring nutrition advice to individuals with epilepsy.
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Affiliation(s)
- Seema Thowfeek
- Departments of Neuroscience and Neurology, The Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria, Australia.
| | - Neha Kaul
- Departments of Neuroscience and Neurology, The Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria, Australia; Nutrition Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ibolya Nyulasi
- Nutrition Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Departments of Neuroscience and Neurology, The Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Departments of Neuroscience and Neurology, The Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria, Australia
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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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15
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Tawakul AA, Alqurashi AA, Altayyar SA, Bugis AH, Althobaiti FS, Almatrafi KM, Algahtani RM, Imam AA, Babteen OM. Public Knowledge, Awareness, Attitudes, and Practices Regarding Seizure Attacks Among People of Makkah City. Cureus 2022; 14:e32485. [PMID: 36644092 PMCID: PMC9836322 DOI: 10.7759/cureus.32485] [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] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Seizures can occur as a result of a variety of health issues. Epilepsy is a common neurological disease and it is the most prevalent cause of seizures. Epileptic patients might experience a seizure attack at any moment. The aim of this study is to assess public knowledge, awareness, attitudes, and practices toward seizure attacks among residents of Makkah city. METHODS A cross-sectional study was conducted utilizing an online questionnaire, which was distributed through various social media platforms. The questionnaire consisted of five parts, taking sociodemographic characteristics into consideration, and evaluating knowledge, awareness, attitudes, and practices among the general population of Makkah city. RESULTS A total of 401 participants completed the study questionnaire: 280 (69.8%) participants were females and 121 (30.2%) were males. Overall knowledge regarding epilepsy among the study participants was evaluated. A total of 132 (32.9%) participants had a good level of knowledge, while 269 (67.1%) exhibited poor knowledge. In addition, students had significantly better knowledge (44.7%) than individuals who were employed, retired, or unemployed (27.7%), (P=.004). Furthermore, participants who had previously heard about epilepsy were more knowledgeable (34.3%) than those who had not (P =.041). Additionally, participants who attended a course on seizure control (46.7%) had significantly better knowledge than those who did not (31.2%), (P=.037). CONCLUSION This study revealed that most of our sample of Makkah city residents had poor overall knowledge of epilepsy and seizure attacks. A health education program and awareness campaigns could help improve this lack of knowledge in Makkah city.
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Affiliation(s)
- Abdullah A Tawakul
- Department of Internal Medicine/Neurology, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Atheer A Alqurashi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Shahad A Altayyar
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Ashwaq H Bugis
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Fadi S Althobaiti
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Khalid M Almatrafi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Rami M Algahtani
- Department of Internal Medicine/Neurology, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Ahmad A Imam
- Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Omar M Babteen
- Department of Physiology, College of Medicine, Umm Al-Qura University, Makkah, SAU
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16
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Goel P, Singh G, Bansal V, Sharma S, Kumar P, Chaudhry R, Bansal N, Chaudhary A, Sharma S, Sander JW. Psychiatric comorbidities among people with epilepsy: A population-based assessment in disadvantaged communities. Epilepsy Behav 2022; 137:108965. [PMID: 36343531 DOI: 10.1016/j.yebeh.2022.108965] [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: 04/09/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
UNLABELLED Psychiatric disorders are frequent among people with epilepsy but often under-recognized. The diagnosis and treatment of these disorders in low- and low-middle-income countries (LMICs) are challenging. METHODS This cross-sectional survey included people recruited during a community epilepsy screening program involving 59,509 individuals from poor communities in Ludhiana in Northwest India. Adults (age ≥18 years) with confirmed epilepsy on antiseizure medications were screened for depression and anxiety using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7) twice over two years of follow-up. They were later interviewed for symptoms using the Brief Psychiatric Rating Scale, which was then confirmed by assessments by an experienced psychiatrist. RESULTS Of the 240 people with confirmed epilepsy, 167 (70%) were adults, of whom, 116 (70%) eventually participated in the study. The NDDI-E with a cut-off of 15 identified depression in 14 (12%) of 116 people after one year of follow-up and 17 (15%) at two years. The GAD-7 using a cut-off of 6 identified 22 (19%) at one year and 32 (28%) with anxiety at two years. The area under the curves for NDDI-E was estimated as 0.62 (95%CI, 0.51-0.73; SE: 0.06; p = 0.04) and for GAD-7 as 0.62 (95%CI, 0.46-0.78; SE: 0.08; p = 0.12). Brief Psychiatric Rating Scale identified 63 (54%) people with psychiatric symptoms, for whom, a psychiatric diagnosis was confirmed in 60 (52%). A psychiatric diagnosis was associated with education below high school [Odds Ratio (OR): 2.59, 95%CI, 1.12-5.1; p = 0.03], later age of seizure onset (OR, 1.05, 95%CI: 1.0-1.10; p = 0.04), seizure frequency of at least one/year at enrolment (OR, 2.36, 95%CI: 1.0-5.58; p = 0.05) and the use of clobazam (OR, 5.09, 95%CI, 1.40-18.42; p = 0.01). CONCLUSION Depression and anxiety are common in people with epilepsy. Our findings underscore the low yields of screening instruments, NDDI-E and GAD-7, and comparatively better professionally-administered diagnostic assessments in resource-limited settings in LMICs. Moreover, previously established cut-offs do not apply to the community studied.
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Affiliation(s)
- Parveen Goel
- Research & Development Unit, Dayanand Medical College, Ludhiana, India; Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - Gagandeep Singh
- Research & Development Unit, Dayanand Medical College, Ludhiana, India; Department of Neurology, Dayanand Medical College, Ludhiana, India; UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom.
| | - Vasu Bansal
- Department of Medicine, Dayanand Medical College, Ludhiana, India
| | - Suman Sharma
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Pankaj Kumar
- Department of Psychiatry, Dayanand Medical College, Ludhiana, India
| | - Rupesh Chaudhry
- Department of Psychiatry, Dayanand Medical College, Ludhiana, India
| | - Namita Bansal
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Anurag Chaudhary
- Department of Social & Preventive Medicine, Dayanand Medical College, Ludhiana, India
| | - Sarit Sharma
- Department of Social & Preventive Medicine, Dayanand Medical College, Ludhiana, India
| | - Josemir W Sander
- UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, The Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 61004, China.
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Association between epilepsy and risk of depression: A meta-analysis. Psychiatry Res 2022; 312:114531. [PMID: 35413534 DOI: 10.1016/j.psychres.2022.114531] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent studies provided inconsistent evidence for the association between epilepsy and risk of depression. METHODS We searched for articles published in the databases (Web of Science, Google Scholar and PubMed) and before December 2021. We used STATA 12.0 software to compute odds ratios (ORs)/relative risks (RRs) and their 95% confidence intervals (CIs). RESULTS The meta-analysis indicated that epilepsy was associated with an increased risk of depression with a random effects model (OR/RR = 2.05; 95% CI: 1.77-2.37, I2 = 37.7%, p = 0.036). Subgroup studies indicated that epilepsy was associated with an increased risk of depression in both case-control and cohort studies (case-control studies: OR = 2.32; 95% CI: 1.91-2.82; cohort studies: RR = 1.71; 95% CI: 1.53-1.92). Subgroup studies indicated that epilepsy was associated with an increased risk of depression in Asian, African and Caucasian populations (Asian: OR/RR = 2.42; 95% CI: 1.48-3.95; African: OR/RR = 2.48; 95% CI: 1.88-3.28; Caucasian: OR/RR = 1.86; 95% CI: 1.60-2.15). Subgroup studies showed that epilepsy was associated with an increased risk of depression among adolescents and adults (adolescents: OR/RR = 2.54; 95% CI: 1.86-3.46; adults: OR/RR = 2.22; 95% CI: 1.79-2.75). CONCLUSIONS Epilepsy is at increased risk of depression comorbidity.
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18
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Tenger M, Van Meervenne S, Varjonen K, Tidholm A, Rohdin C. Epilepsy in British Shorthair cats in Sweden. J Feline Med Surg 2022; 24:550-557. [PMID: 34431738 PMCID: PMC11104252 DOI: 10.1177/1098612x211036795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The primary objective of this study was to investigate the prevalence of epileptic seizures and of presumed idiopathic epilepsy (PIE, describing epilepsy of unknown origin) in a cohort of British Shorthair (BSH) cats in Sweden. The secondary objective was to describe epileptic seizure characteristics and outcome for cats with PIE. METHODS Owners of BSH cats born between 2006 and 2016 and registered with SVERAK (the Swedish Cat Clubs' National Association) were invited to reply to a questionnaire about their cat's general health. Owners who indicated that their cat had experienced epileptic seizures were invited to participate in an in-depth telephone interview about the epileptic seizures. The clinical characteristics of epileptic seizures in BSH cats were determined from the results of the interview. RESULTS In this population comprising 1645 BSH cats (representing 28% of registered BSHs), the prevalence of epileptic seizures was 0.9% and for PIE it was 0.7%. BSH cats with PIE presented with infrequent but consistent epileptic seizures. Twenty-seven percent of BSH cats with epileptic seizures had cluster seizures but none presented with status epilepticus. None of the BSH cats was treated with antiepileptic drugs, and none of the owners reported epileptic seizure remission in their cat. CONCLUSIONS AND RELEVANCE The prevalence of PIE in this population of BSH cats was 0.7%. The prevalence of epileptic seizures was 0.9%. In general, PIE in the BSH cat displayed a relatively benign phenotype where progression of epileptic seizures was uncommon.
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Affiliation(s)
| | | | | | - Anna Tidholm
- Anicura Albano Small Animal Hospital, Stockholm, Sweden
| | - Cecilia Rohdin
- Anicura Albano Small Animal Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Morales DR, Moreno-Martos D, Matin N, McGettigan P. Health conditions in adults with HIV compared with the general population: A population-based cross-sectional analysis. EClinicalMedicine 2022; 47:101392. [PMID: 35497059 PMCID: PMC9046106 DOI: 10.1016/j.eclinm.2022.101392] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Life expectancy in adults with human immunodeficiency virus (HIV) has increased and managing other health conditions is increasingly important for patients and healthcare planning. The aim of this study was to examine the prevalence and association between different health conditions and HIV status. METHODS We performed a cross-sectional analysis of adult UK Clinical Practice Research Datalink primary care electronic medical records linked to hospital admissions as of Nov 30, 2015. We examined 47 health condition groups and 304 physical and mental health conditions by HIV status, after adjustment for age, sex, social deprivation status using logistic regression. FINDINGS There were 964 patients with HIV (61.7% male; 92.8% aged <65 years) and 941,113 non-HIV patients (49.4% male; 75.2% aged <65 years). Condition groups with the greatest prevalence in HIV that were also highly prevalent in adults without HIV included: lipid disorder (41.4% vs 40.2%), and hypertension (19.1% vs 24.6%). Following adjustment, 18 (37.5%) condition groups were more likely in adults with HIV and ten (20.8%) were less likely. Individual conditions that were less likely in adults with HIV included: atrial fibrillation (odds ratio [OR] 0.37 [95% CI 0.20-0.64]) and hypertension (OR_0.78 [0.65-0.94]); rheumatoid arthritis (OR 0.27 [0.05-0.84]); asthma (OR_0.65 (0.53-0.80]); and certain eye diseases such as macular degeneration (OR_0.30 [0.09-0.70]). Meanwhile individual conditions that were more likely included: liver fibrosis, sclerosis, and cirrhosis (OR_3.23 [1.85-5.20]); pulmonary embolism (OR_2.06 [1.15-3.36]); male infertility (OR_2.23 [1.50-3.16]) and female infertility (OR_2.01 [1.34-2.88]); bipolar disorder (OR_2.93 [1.52-5.05]) and depression (OR_1.49 [1.28-1.71]); cervical malignancy (OR_4.64 [1.15-12.15]); and infections. INTERPRETATION Comorbidity is common in adults with HIV, with physical and mental health conditions spanning a wide spectrum. HIV management should consider multidisciplinary care models to provide optimal patient care. FUNDING The project was funded by the Bart's Charity; DRM was funded by a Wellcome Trust Clinical Research Career Development Fellowship; DRM and DMM received funding from the HDR-UK Precision therapeutics programme.
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Affiliation(s)
- Daniel R. Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
- Department of Public Health, University of Southern Denmark, Denmark
- Corresponding author at: Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom.
| | - David Moreno-Martos
- Division of Population Health and Genomics, University of Dundee, United Kingdom
| | - Nashaba Matin
- Barts Health NHS Trust, Grahame Hayton Unit, Royal London Hospital, London, United Kingdom
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, United Kingdom
- Corresponding author.
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20
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Zhang CQ, Li HY, Wan Y, Bai XY, Gan L, Sun HB. Effect of different physical activity training methods on epilepsy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29085. [PMID: 35356937 PMCID: PMC10684114 DOI: 10.1097/md.0000000000029085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Over the past few decades, people with epilepsy were advised not to engage in sports based on the fear that sporting activity may cause injuries, potentially induce seizures, and have a negative effect on disease course. However, in recent years, numerous studies have indicated a positive role of physical exercise in reducing the frequency of seizures and improving health condition of patients with epilepsy. The purpose of this study was to compare the effects of different physical exercise programs on the symptomatology and health condition of individuals with epilepsy and provide guidance for selecting the optimal modality of physical exercise for patients with epilepsy via a meta-analysis of available literature. METHODS A literature search was carried out in MEDLINE via PubMed, Cochrane Library, EBSCO, Embase, China National Knowledge (CNKI), and Wan fang databases to gather relevant data about different physical exercise modalities and epilepsy. We will use Endnote X9 software for studies selection and Stata16.0 software for the data analysis. RESULTS This present study aimed to provide the most up to date evidence and recommendations for clinicians and epilepsy patients to choose an optimal type of exercise. CONCLUSION Aerobic exercise and resistance exercises both had a positive effect on epilepsy patients. Persons with epilepsy should be encouraged to participate in sports activities.INPLASY registration number: INPLASY202220070.
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Affiliation(s)
| | | | | | | | | | - Hong Bin Sun
- Correspondence: Hong Bin Sun, Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu 610072, China (e-mail: ).
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21
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AD M, JP P, A A, JP L, CA H. The influence of demographics and comorbidity on persistence with anti-seizure medication. Seizure 2022; 97:88-93. [DOI: 10.1016/j.seizure.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022] Open
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22
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Terman SW, Kerr WT, Aubert CE, Hill CE, Marcum ZA, Burke JF. Adherence to Antiseizure vs Other Medications Among US Medicare Beneficiaries With and Without Epilepsy. Neurology 2022; 98:e427-e436. [PMID: 34893556 PMCID: PMC8793102 DOI: 10.1212/wnl.0000000000013119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/16/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The objectives of this study were to compare adherence to antiseizure medications (ASMs) vs non-ASMs among individuals with epilepsy, to assess the degree to which variation in adherence is due to differences between individuals vs between medication classes among individuals with epilepsy, and to compare adherence in individuals with vs without epilepsy. METHODS This was a retrospective cohort study using Medicare. We included beneficiaries with epilepsy (≥1 ASM, plus ICD-9-CM diagnostic codes) and a 20% random sample without epilepsy. Adherence for each medication class was measured by the proportion of days covered (PDC) in 2013 to 2015. We used Spearman correlation coefficients, Cohen κ statistics, and multilevel logistic regressions. RESULTS There were 83,819 beneficiaries with epilepsy. Spearman correlation coefficients between ASM PDCs and each of the 5 non-ASM PDCs ranged from 0.44 to 0.50; Cohen κ ranged from 0.33 to 0.38; and within-person differences between the PDC of each ASM minus the PDC of each non-ASM were all statistically significant (p < 0.01), although median differences were all very close to 0. Fifty-four percent of variation in adherence across medications was due to differences between individuals. Adjusted predicted probabilities of adherence were as follows: ASMs 74% (95% confidence interval [CI] 73%-74%), proton pump inhibitors 74% (95% CI 74%-74%), antihypertensives 77% (95% CI 77%-78%), selective serotonin reuptake inhibitors 77% (95% CI 77%-78%), statins 78% (95% CI 78%-79%), and levothyroxine 82% (95% CI 81%-82%). Adjusted predicted probabilities of adherence to non-ASMs were 80% (95% CI 80%-81%) for beneficiaries with epilepsy vs 77% (95% CI 77%-77%) for beneficiaries without epilepsy. DISCUSSION Among individuals with epilepsy, ASM adherence and non-ASM adherence were moderately correlated, half of the variation in adherence was due to between-person rather than between-medication differences, adjusted adherence was slightly lower for ASMs than several non-ASMs, and epilepsy was associated with a quite small increase in adherence to non-ASMs. Nonadherence to ASMs may provide an important cue to the clinician to inquire about adherence to other potentially life-prolonging medications as well. Although efforts should focus on improving ASM adherence, patient-level rather than purely medication-specific behaviors are also critical to consider when developing interventions to optimize adherence.
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Affiliation(s)
- Samuel W Terman
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle.
| | - Wesley T Kerr
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
| | - Carole E Aubert
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
| | - Chloe E Hill
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
| | - Zachary A Marcum
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
| | - James F Burke
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
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23
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Morley K. Enhancing patients' experiences of living with epilepsy. Nurs Stand 2022; 37:29-34. [PMID: 34719902 DOI: 10.7748/ns.2021.e11686] [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] [Accepted: 02/02/2021] [Indexed: 06/13/2023]
Abstract
Epilepsy is a multifaceted neurological condition that has many causes. Living with epilepsy can have significant physical, psychological and social effects on an individual and their family. A patient's experience of living with epilepsy can be influenced by multiple factors, such as pre-existing comorbidities or underlying risk factors for developing comorbidities. This article explores the experiences of patients with epilepsy at the point of diagnosis, in hospital and when taking anti-epileptic drugs. It also details various evidence-based interventions that can improve these patients' experiences and the quality of care that they receive.
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Affiliation(s)
- Kim Morley
- Hampshire Hospitals NHS Foundation Trust, Winchester, England
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24
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Comparison of physical fitness, activity, and quality of life of the children with epilepsy and their healthy peers. Epilepsy Res 2021; 178:106795. [PMID: 34741994 DOI: 10.1016/j.eplepsyres.2021.106795] [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: 04/30/2021] [Revised: 09/03/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify physical fitness and activity levels, and health-related quality of life of children with epilepsy in Turkey and compare the results with their healthy peers. METHODS The study included 21 children with epilepsy (with no seizures and not taking anti-epileptic drugs for at least a year) and 20 healthy peers. The FitnessGram Physical Fitness Test Battery was used to assess physical fitness, the 6-Minute Walk Test to assess physical performance, the Pediatric Quality of Life Inventory 4.0 (PedsQL) to assess the quality of life, and a pedometer was used to assess the physical activity of the children. RESULTS The physical fitness assessments including the trunk-lift test and flamingo balance test results were significantly lower in the children with epilepsy (p < 0.05). There was no significant difference between the groups in terms of BMI, the cadence-based curl-up test, the push-up test and the back saver sit/reach test (p > 0.05). Physical activity, physical performance, and quality of life results were significantly lower in children with epilepsy (p < 0.05). CONCLUSION The presence of epilepsy may negatively affect many aspects of physical fitness, physical activity, and quality of life in childhood. The children with epilepsy adopted a more sedentary lifestyle than their healthy peers. Quality of life outcomes reveal that epilepsy has negative physical and psychosocial effects on children. These results support the necessity of raising awareness in both health professionals and families to encourage their children to be more active.
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25
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Vacca M, Fernandes M, Spanetta M, Placidi F, Izzi F, Lombardo C, Mercuri NB, Liguori C. Depressive symptoms in patients with epilepsy and clinically associated features in a single tertiary center. Neurol Sci 2021; 43:1965-1974. [PMID: 34528181 PMCID: PMC8860796 DOI: 10.1007/s10072-021-05589-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Although depressive symptoms are the most common psychiatric comorbidity in epilepsy, they remain underestimated and untreated in a large proportion of patients. The purpose of this study was to evaluate depression severity and related clinical features in people with epilepsy using a well-reliable self-report index of mood, the Beck Depression Inventory-II (BDI-II). One-hundred seventeen adult patients with epilepsy were recruited from a tertiary epilepsy center and completed the BDI-II. A single-item analysis of the 21 questions of the BDI-II was computed and differences between women and men in each depressive symptom were evaluated. Correlation and regression analyses were used to identify clinical features associated with the severity of depression. Results showed gender differences in some items, with women reporting overall higher depression severity than men. The most common symptoms regarded domains of sleeping patterns, tiredness, and loss of energy. Regression evidence suggested that being female, having an epilepsy duration < 10 years, as well as being treated with psychotropic drugs and reporting generalized seizure, were associated with higher depression severity. Despite its cross-sectional nature, this study reinforces the importance of investigating and possibly treating depressive symptoms in adult patients with epilepsy, since they negatively impact well-being, daytime activities, and sleep. Further studies identifying pharmacological and non-pharmacological treatments for depression in epilepsy need to be planned.
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Affiliation(s)
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Spanetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Placidi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Francesca Izzi
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | | | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.,IRCSS Santa Lucia Foudantion, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. .,Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.
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26
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Whitney DG. Osteoporosis medication is associated with mortality risk reduction among adults with epilepsy: An observational study. Bone 2021; 150:116003. [PMID: 33984552 DOI: 10.1016/j.bone.2021.116003] [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: 11/05/2020] [Revised: 03/31/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adults with epilepsy have an increased risk of fragility fractures, which contributes to an accelerated rate of premature morbidity and mortality. In the general population, osteoporosis treatment has shown improvements in health and survival, possibly through improving skeletal robustness; however, the effect of osteoporosis medication on survival among adults with epilepsy has not been investigated. The purpose of this propensity score-matched, observational cohort study was to determine if osteoporosis medication was associated with mortality risk among adults with epilepsy. An exploratory analysis then examined the association between the type of osteoporosis medication with mortality. METHODS Data from 01/01/2012-09/30/2017 was extracted from Optum Clinformatics® Data Mart. Adults ≥50 years of age with epilepsy that were treatment naïve for and initiated osteoporosis medication (EP new users) were the primary group of interest, and were compared to adults with epilepsy that were not prescribed osteoporosis medication (EP no users) and adults without epilepsy that were treatment naïve for and initiated osteoporosis medication (w/o EP new users). Comparison groups were matched 1:4 to EP new users (n = 733; comparison groups, n = 2932) for demographics, glucocorticoid and antiseizure medication, prior 12-month fracture, and the Elixhauser comorbidity index. Crude incidence rate (IR) and IR ratio (IRR and 95% confidence intervals [CI]) was estimated for mortality for up to 3 years of follow-up. For new users, the association between type of osteoporosis medication (bisphosphonates vs. others) and mortality was explored using Cox proportional hazards regression after adjusting for all covariates. RESULTS For new users, the majority of the prescribed osteoporosis medications were bisphosphonates (~83%). The incidence of mortality for EP new users was lower compared to EP no users (IRR = 0.69; 95%CI = 0.52-0.93), but elevated compared to w/o EP new users (IRR = 1.42; 95%CI = 1.04-1.94). Comparing bisphosphonates to other medications for new users (P for EP group interaction = 0.089), EP new users showed a lower fully adjusted hazard ratio for mortality (HR = 0.56; 95%CI = 0.30-1.04), but was marginally insignificant (P = 0.066), while w/o EP new users showed no evidence of an association (HR = 1.09; 95%CI = 0.72-1.65). CONCLUSIONS Osteoporosis medication initiation was associated with a lower 3-year risk of mortality among adults with epilepsy. The exploratory analysis revealed potential evidence of a unique protective effect of bisphosphonates as compared to other osteoporosis medications on 3-year mortality for adults with epilepsy.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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27
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Pakdaman H, Harandi AA, Gharagozli K, Alaeddini F, Esfandani A, Mirbehbahani SH, Doroudi T, Kolivand P, Bahrami P, Kazemi H. Epilepsy lifetime prevalence in Iran: a large population- based national survey. Sci Rep 2021; 11:9437. [PMID: 33941831 PMCID: PMC8093423 DOI: 10.1038/s41598-021-89048-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 04/08/2021] [Indexed: 11/09/2022] Open
Abstract
Epilepsy has garnered increased public health focus because patients who suffer from epilepsy experience pronounced and persistent health and socioeconomic disparities despite treatment and care advances. The epidemiology of epilepsy is diverse in different countries and regions. This nationwide population-based cross-sectional study was conducted to determine the life time prevalence and health related factors of epilepsy for the first time in Iran through a two-phase door-to-door survey method. In phase I, a screening for epilepsy was performed on 68,035 people. Then in phase II, after the neurological evaluation of participants and reviewing medical records, 1130 subjects with epilepsy was confirmed. The life time prevalence of epilepsy was achieved to be 16.6 per 1000 people (95% CI 15.4-17.8) with the average age onset 19.1 ± 21.1 (active prevalence 9.5 per 1000 people). Focal seizure (59.3%), generalized epilepsy (38%) and unknown types of epilepsy (2.7%) were detected among participants. The overall life time prevalence of febrile convulsion was 4.1 per 1000 people. The frequency of attacks per year and per month were 3.0 ± 1.6 and 0.5 ± 0.1, respectively. Age-specific life time prevalence was highest among the age group of 15-19 years old [32.7 per 1000 persons (95% CI 29.1-36.8)] and it was higher in male (53.8%) than female (46.2%) participants. Our results showed that the life time prevalence of epilepsy in Iran is higher than worldwide average.
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Affiliation(s)
- Hossein Pakdaman
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Amini Harandi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Koroush Gharagozli
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshid Alaeddini
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Esfandani
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Taher Doroudi
- Shefa Neuroscience Research Center, Khatam-Ol-Anbia Hospital, Tehran, Iran
| | | | - Parviz Bahrami
- Shefa Neuroscience Research Center, Khatam-Ol-Anbia Hospital, Tehran, Iran
| | - Hadi Kazemi
- Shefa Neuroscience Research Center, Khatam-Ol-Anbia Hospital, Tehran, Iran
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Uepping P, Hamer H, Scholten J, Kostev K. Physical and mental health comorbidities of patients with epilepsy in Germany - A retrospective cohort study. Epilepsy Behav 2021; 117:107857. [PMID: 33636528 DOI: 10.1016/j.yebeh.2021.107857] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 01/11/2023]
Abstract
AIMS The aim of this study was to estimate the prevalence of physical and psychological comorbidities in patients with epilepsy in Germany in order to better understand the complex clinical picture and its consequences. METHODS This retrospective cohort study included adult individuals with a diagnosis of epilepsy between January 2018 and December 2018 (index date). Patients with epilepsy were matched 1:1 with patients without epilepsy by age, sex, and physician. The study outcomes included the associations between epilepsy and different physical and mental disorders documented within 365 days after the index date as well as multimorbidity defined as at least two, three, four, and five different diagnoses. The present study used multivariate logistic regression models with all study disorders as dependent variables and epilepsy as an impact variable. RESULTS After 1:1 matching, the present study included 7942 patients with and 7942 patients without epilepsy (mean age: 58.0 years; 49.7% female). Epilepsy was significantly positively associated with nine disorders, and the strongest associations were with mental retardation (Odds Ratio (OR): 21.11 (95% Confidence Intervals (CI): 12.52-35.59)), cerebrovascular diseases (OR: 3.14 (95% CI: 2.80-3.55)), and dementia (OR: 1.72 (95% CI: 1.47-2.01)). Epilepsy was associated with significantly increased odds of multimorbidity. CONCLUSION In summary, individuals with epilepsy have an increased prevalence of comorbidities that increase with age. Further research should be undertaken in this area, including the etiology of comorbidities.
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Affiliation(s)
| | - Hajo Hamer
- Department of Neurology, Epilepsy Center, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Karel Kostev
- University Hospital of Marburg, Marburg, Germany; Epidemiologie, IQVIA, Frankfurt am Main, Germany.
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Askarieh A, Morrison I, Ross K, McCowan C, Matthews K, Kidd B, Heath CA. Medication adherence, utilization of healthcare services, and mortality of patients with epilepsy on opiate replacement therapy: A retrospective cohort study. Epilepsy Behav 2021; 117:107829. [PMID: 33621811 DOI: 10.1016/j.yebeh.2021.107829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/15/2021] [Accepted: 01/25/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Substance misuse is not uncommonly recognized in people with epilepsy (PWE). Mortality is significantly greater in those with comorbid substance misuse, but it remains unclear whether epilepsy care and management contribute to this. This cohort study aimed to compare the rates of mortality in PWE receiving opiate replacement therapy (ORT) and PWE alone, as well as evaluate their medication adherence, levels of engagement with epilepsy services as currently delivered, and utilization of unscheduled hospital care. MATERIAL AND METHODS A 5-year historical cohort for PWE was identified and manually validated using electronic patient records registered with NHS Tayside. Overall incidence rates for mortality and contact with emergency health care services were calculated for PWE receiving ORT and PWE alone. Engagement with outpatient epilepsy services was also noted. Adherence to antiepileptic drugs (AEDs) was expressed in terms of medication possession ratio (MPR). RESULTS Of the 1297 PWE attending a tertiary care epilepsy service, 68 (5.3%) PWE were receiving ORT. The mortality rate was significantly greater in PWE on ORT in comparison to PWE only (7.4% vs 1.7 %; P < 0.05; relative risk of death: 4.34, 95% CI 1.19-15.7), as well as the incidence of emergency healthcare services contact being higher (24.5% vs 17.7%; P < 0.05; incidence rate ratio: 1.39, 95% CI: 1.12-1.71). Poor adherence to AEDs was also more common in PWE on ORT (28.4% vs 23.5%; P = 0.02), as well as failure to engage with elective outpatient services (8.4% vs 3.0%; P < 0.05; rate ratio 2.77, 95% CI: 1.86-4.1). CONCLUSION People with epilepsy on ORT are less likely to engage with elective epilepsy services as currently delivered or take AEDs as prescribed despite most of these patients having daily attendance at a community pharmacist. This may contribute to the significantly increased rates of mortality and unscheduled hospital care. Clinicians and policymakers should consider service redesign to meet the demands of this high-risk population in an attempt to reduce mortality and morbidity.
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Affiliation(s)
- Amber Askarieh
- Department of Neurology, Institute of Neurological Sciences, Langlands Drive, Glasgow G51 4LB, UK.
| | - Ian Morrison
- Department of Neurology, Ninewells Hospital, James Arrot Drive, Dundee DD2 1SG, UK
| | - Kevin Ross
- Institute of Inflammation, Infection & Immunology, College of Medicine, Veterinary & Life Sciences, University of Glasgow, Sir Graeme Davies Building, 120 University Place, Glasgow G12 8TA, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, N Haugh, St Andrew's KY16 9TF, UK
| | - Keith Matthews
- Division of Molecular and Clinical Medicine, University of Dundee, Nethergate, Dundee DD1 4HN, UK
| | - Brian Kidd
- Division of Molecular and Clinical Medicine, University of Dundee, Nethergate, Dundee DD1 4HN, UK
| | - Craig A Heath
- Department of Neurology, Institute of Neurological Sciences, Langlands Drive, Glasgow G51 4LB, UK
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30
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Associations of individual and structural socioeconomic status with cognition and mental distress in pharmacoresistant focal epilepsy. Epilepsy Behav 2021; 116:107726. [PMID: 33493801 DOI: 10.1016/j.yebeh.2020.107726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Epilepsy is often associated with low socioeconomic status (SES). People with epilepsy (PWE) also suffer from cognitive dysfunction and mental distress. In the general population, these constraints are related to individual and structural SES. However, in PWE, cognitive dysfunction and mental distress have been mainly attributed to biological factors such as brain lesions or pharmacological treatment, whereas comprehensive studies on possible social determinants are missing. Here, we study associations of individual and structural SES with cognition and mental distress in PWE. METHODS We retrospectively studied 340 adult patients with pharmacoresistant focal epilepsy from Berlin treated at a tertiary epilepsy center. Individual SES (education, employment, and income), structural SES (social index of district and neighborhood), and their interactions were examined. Associations between social variables and verbal learning, psychomotor speed, and mental distress were analyzed with multiple regression analyses, controlling for demographic and medical variables and intelligence. RESULTS Our sample had lower educational levels and lived more frequently in low SES neighborhoods compared to the general population of Berlin. Thirty percent showed reduced verbal learning, 31% had deficits in psychomotor speed, and 20% revealed significant mental distress. Lower structural SES was related to lower psychomotor speed (ΔR2 = 0.9%) and higher mental distress (ΔR2 = 1.6%). Employment was related to verbal learning (ΔR2 = 0.7%) and psychomotor speed (ΔR2 = 1.2%). Income and education were linked to mental distress (ΔR2 = 5%). Neighborhood and individual SES covered more than half of the explained variance in mental distress. Furthermore, interactions between individual and structural SES were identified. CONCLUSION We confirm cognitive deficits, significant mental distress, and individual and structural social disadvantage in PWE. Our findings indicate that individual and structural SES are related to cognitive and emotional well-being beyond demographic and medical characteristics. As a clinical implication, individual and structural SES should be considered when interpreting neuropsychological findings.
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31
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Terman SW, Hill CE, Burke JF. Disability in people with epilepsy: A nationally representative cross-sectional study. Epilepsy Behav 2020; 112:107429. [PMID: 32919202 DOI: 10.1016/j.yebeh.2020.107429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of this study was to explore the prevalence and predictors of limitations causing disability in patients treated for seizures or epilepsy compared with patients without epilepsy. METHODS This was a retrospective cross-sectional study using the National Health and Nutrition Examination Survey (NHANES). We included all participants ≥20 years old for 2013-2018. We classified patients as having epilepsy if they reported taking at least one prescription medication to treat seizures or epilepsy. Physical, mental, and social limitations were determined from interview questions. We report the prevalence of any limitation and total number of limitations for participants without vs. with epilepsy using serial negative binomial regressions and severity of individual limitations according to epilepsy status. RESULTS We included 17,057 participants, of whom 148 (0.8%) had epilepsy. Overall, 80% (95% confidence interval [CI]: 73%-86%) with epilepsy vs. 38% (95% CI: 36%-39%) without epilepsy reported at least 1 limitation (p < 0.01). The mean number of limitations was 7.5 (95% CI: 6.2-8.8) for those with epilepsy vs. 2.4 (95% CI: 2.3-2.6) for those without epilepsy (p < 0.01). Epilepsy was associated with an incidence rate ratio (IRR) of 3.1 (95% CI: 2.6-3.7) in an unadjusted negative binomial regression. After adjusting for demographics and comorbidities, this association was no longer significant (IRR: 1.2, 95% CI: 0.9-1.7). Limitations cited by 40-50% of participants with epilepsy included stooping/kneeling/crouching, standing for long periods of time, and pushing/pulling objects. Limitation severity was consistently higher in patients with epilepsy. CONCLUSIONS Patients with epilepsy had 3.1 times as many physical, mental, or social limitations compared with those without epilepsy, and disability severity was consistently higher. This effect was attenuated after considering baseline variables such as smoking and depression severity. Our work implies the importance of structured mental health screening and self-management programs targeting mood, weight, and lifestyle as potential leverage points towards alleviating epilepsy-related disability.
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Affiliation(s)
- Samuel W Terman
- University of Michigan, Department of Neurology, Ann Arbor, MI 48109, USA; University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA.
| | - Chloe E Hill
- University of Michigan, Department of Neurology, Ann Arbor, MI 48109, USA; University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA.
| | - James F Burke
- University of Michigan, Department of Neurology, Ann Arbor, MI 48109, USA; University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA.
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Terman SW, Aubert CE, Hill CE, Maust DT, Betjemann JP, Boyd CM, Burke JF. Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study. Epilepsy Behav 2020; 111:107261. [PMID: 32629416 PMCID: PMC7869064 DOI: 10.1016/j.yebeh.2020.107261] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the study was to characterize the prevalence of polypharmacy and central nervous system (CNS)-acting medications in patients with epilepsy, and particular types of medications. METHODS This was a retrospective cross-sectional study using data from the nationally representative National Health and Nutrition Examination Survey (NHANES). We included patients who reported taking at least one prescription medication in order to treat seizures or epilepsy during NHANES survey years 2013-2016. We assessed the number and types of drugs and predictors of total number of medications using a negative binomial regression. We then assessed prevalence of polypharmacy (≥5 medications), CNS polypharmacy (≥3 CNS-acting medications) and additional CNS-acting medications, and drugs that lower the seizure threshold (i.e., bupropion and tramadol), and extrapolated prevalence to estimated affected US population. RESULTS The NHANES contained 20,146 participants, of whom 135 reported taking ≥1 antiseizure medication (ASM) for seizures or epilepsy representing 2,399,520 US citizens using NHANES's sampling frame. Patients reported taking a mean 5.3 (95% confidence interval (CI): 4.3-6.3) prescription medications. Adjusting for race, sex, and uninsurance, both age and number of chronic conditions predicted increased number of medications (incident rate ratio (IRR) per decade: 1.16, 95% CI: 1.04-1.28; IRR per chronic condition: 1.19, 95% CI: 1.11-1.27). Polypharmacy was reported by 47% (95% CI: 38%-57%) of patients, CNS polypharmacy by 34% (23%-47%), benzodiazepine use by 21% (14%-30%), opioid use by 16% (11%-24%), benzodiazepine plus opioid use by 6% (3%-14%), and 6% (2%-15%) reported a drug that lowers the seizure threshold. Twelve percent (7%-20%) took an opioid with either a benzodiazepine or gabapentinoid. CONCLUSIONS Polypharmacy is common in patients with epilepsy. Patients taking ASMs frequently reported also taking other CNS-acting medications (i.e., opioids, benzodiazepines, seizure threshold-lowering medications), and medication combinations with black box warnings. Central nervous system polypharmacy poses health risks. Future research is needed to explore drivers of polypharmacy and strategies to help mitigate potentially harmful prescription use in this high-risk population.
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Affiliation(s)
- Samuel W Terman
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA.
| | - Carole E Aubert
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA; Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109, USA.
| | - Chloe E Hill
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA.
| | - Donovan T Maust
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109, USA; University of Michigan Department of Psychiatry, Ann Arbor, MI 48109, USA.
| | - John P Betjemann
- University of California San Francisco, Weill Institute for Neurosciences, San Francisco, USA.
| | - Cynthia M Boyd
- Johns Hopkins University, Center on Aging and Health, Baltimore, MD 21205, USA.
| | - James F Burke
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA.
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Risk for respiratory and cardiovascular disease and mortality after non-trauma fracture and the mediating effects of respiratory and cardiovascular disease on mortality risk among adults with epilepsy. Epilepsy Res 2020; 166:106411. [DOI: 10.1016/j.eplepsyres.2020.106411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 12/29/2022]
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Tomson T, Muraca G, Razaz N. Paternal exposure to antiepileptic drugs and offspring outcomes: a nationwide population-based cohort study in Sweden. J Neurol Neurosurg Psychiatry 2020; 91:907-913. [PMID: 32651245 DOI: 10.1136/jnnp-2020-323028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/01/2020] [Accepted: 06/08/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the association between paternal use of antiepileptic drugs (AEDs) and adverse neurodevelopmental outcomes and major congenital malformations (MCM) in the offspring. METHODS Using nationwide Swedish registries, we included 1 144 795 births to 741 726 fathers without epilepsy and 4544 births to 2955 fathers with epilepsy. Of these, 2087 (45.9%) were born to fathers with epilepsy who had dispensed an AED during the conception period. Children who had both parents with epilepsy were excluded. The incidence rate of MCM, autism spectrum disorder, attention deficit hyperactivity disorder (ADHD) and intellectual disability in offspring was analysed. RESULTS Offspring of fathers exposed to AEDs did not show an increased risk of MCM (adjusted OR 0.9, 95% CI 0.7 to 1.2), autism (adjusted HR (aHR) 0.9, 95% CI 0.5 to 1.7), ADHD (aHR 1.1, 95% CI 0.7 to 1.9) or intellectual disability (aHR 1.3, 95% CI 0.6 to 2.8) compared with offspring of fathers with epilepsy not exposed to AEDs. Among offspring of fathers with epilepsy who used valproate in monotherapy during conception, rates of autism (2.9/1000 child-years) and intellectual disability (1.4/1000 child-years) were slightly higher compared with the offspring of fathers with epilepsy who did not use AEDs during conception (2.1/1000 child-years autism, 0.9/1000 child-years intellectual disability), but in the propensity-score adjusted analyses, no statistically significant increased risk of adverse outcomes was found. CONCLUSIONS Paternal AED use during conception is not associated with adverse outcomes in the offspring.
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Affiliation(s)
- Torbjörn Tomson
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Giulia Muraca
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Neda Razaz
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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Narayanan J, Simon KC, Choi J, Dobrin S, Rubin S, Taber J, Wang C, Pham A, Chesis R, Hadsell B, Epshteyn A, Wilk G, Tideman S, Meyers S, Frigerio R, Maraganore D. Factors Affecting Cognition and Depression in Adult Patients with Epilepsy. J Epilepsy Res 2020; 9:103-110. [PMID: 32509545 PMCID: PMC7251347 DOI: 10.14581/jer.19018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Epilepsy patients are more likely to experience depressive symptoms and cognitive impairment compared to individuals in the general population. As the reasons for this are not definitively known, we sought to determine what factors correlate most strongly with cognition and a screening test for depression in epilepsy patients. Methods Our study population included 379 adult patients diagnosed with epilepsy or seizure in our neurology clinic. We collected detailed demographic and clinical data during patient visits using structured clinical documentation support tools that we have built within our commercial electronic medical records system (Epic), including a depression score (Neurological Disorders Depression Inventory for Epilepsy, NDDIE) and cognition score test measures (specifically in this study, Mini-Mental State Examination [MMSE]). Medication, age, gender, body mass index, duration of epilepsy, seizure frequency, current number of anti-epileptic medications, years of education were assessed in relation to baseline score as well as change in score from initial visit to first annual follow-up. Results Of the analyzed factors, two statistically significant associations were found after correction for multiple testing. Male gender and lower anti-seizure medication count were associated with better mood, as assessed by NDDIE score, at initial visit. Specifically, male gender was associated with a 1.3 decrease in NDDIE and for each additional anti-seizure medication, there was an associated 1.2 increase in NDDIE. Conclusions However, these factors were not associated with change in NDDIE score from initial to first annual follow-up visit. These findings, although interesting, are preliminary. Additionally, these findings were based on a homogenous (mainly Caucasian) clinic-based population and detailed information on previous medication use was lacking. Further work is needed to replicate these findings and to understand any mechanisms that may explain these associations.
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Affiliation(s)
- Jaishree Narayanan
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kelly Claire Simon
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Janet Choi
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Sofia Dobrin
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Susan Rubin
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jesse Taber
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Charles Wang
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Anna Pham
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Richard Chesis
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Bryce Hadsell
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Alexander Epshteyn
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Gary Wilk
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Samuel Tideman
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Steven Meyers
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Roberta Frigerio
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
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Whitney DG, Bell S, McNamara NA, Hurvitz EA. The mortality burden attributable to nontrauma fracture for privately insured adults with epilepsy. Epilepsia 2020; 61:714-724. [PMID: 32108937 DOI: 10.1111/epi.16465] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/03/2020] [Accepted: 02/10/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Individuals with epilepsy have poor bone development and preservation throughout the lifespan and are vulnerable to nontrauma fracture (NTFx) and post-NTFx complications. However, no studies have examined the contribution of NTFx to mortality among adults with epilepsy. The objective was to determine whether NTFx is a risk factor for mortality among adults with epilepsy. METHODS Data from 2011 to 2016 were obtained from Optum Clinformatics Data Mart, a nationwide claims database from a single private payer in the United States. Diagnosis codes were used to identify adults (≥18 years old) with epilepsy, NTFx, and covariates (demographics and pre-NTFx cardiovascular disease, respiratory disease, diabetes, chronic kidney disease, cancer). Crude mortality rate per 100 person-years was estimated. Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) were determined for mortality, comparing epilepsy and NTFx (EP + NTFx; n = 11 471), epilepsy without NTFx (EP without NTFx; n = 50 384), without epilepsy and with NTFx (without EP + NTFx; n = 423 041), and without epilepsy and without NTFx (without EP without NTFx; n = 6.8 million) after adjusting for covariates. RESULTS The 3-, 6-, and 12-month crude mortality rates were highest among EP + NTFx (12-month mortality rate = 8.79), followed by without EP + NTFx (12-month mortality rate = 4.80), EP without NTFx (12-month mortality rate = 3.06), and without EP without NTFx (12-month mortality rate = 0.47). After adjustments, the mortality rate was elevated for EP + NTFx for all time points compared to EP without NTFx (eg, 12-month HR = 1.70, 95% CI = 1.58-1.85), without EP + NTFx (eg, 12-month HR = 1.41, 95% CI = 1.32-1.51), and without EP without NTFx (eg, 12-month HR = 5.23, 95% CI = 4.88-5.60). Stratified analyses showed higher adjusted HRs of 12-month mortality for EP + NTFx for all NTFx sites (ie, vertebral column, hip, extremities), all age categories (young, middle-aged, older), and for both women and men. SIGNIFICANCE Among adults with epilepsy and compared to adults without epilepsy, NTFx is associated with a higher 12-month mortality rate. Findings suggest that NTFx may be a robust risk factor for mortality among adults with epilepsy.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Sarah Bell
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Nancy A McNamara
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
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Dressler A, Häfele C, Giordano V, Benninger F, Trimmel-Schwahofer P, Gröppel G, Samueli S, Feucht M, Male C, Repa A. The Ketogenic Diet Including Breast Milk for Treatment of Infants with Severe Childhood Epilepsy: Feasibility, Safety, and Effectiveness. Breastfeed Med 2020; 15:72-78. [PMID: 31770024 DOI: 10.1089/bfm.2019.0190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: The ketogenic diet (KD) is a high-fat and restricted carbohydrate diet for treating severe childhood epilepsy. In infants, breast milk is usually fully replaced by a ketogenic formula. At our center, mothers are encouraged to include breastfeeding into the KD if still breastfeeding. This retrospective study describes achievement and maintenance of ketosis with or without inclusion of breast milk. Methods: Data were retrieved from a prospective longitudinal database of children treated with KD for epilepsy analyzing infants <1 year of age. The time to achieve clinically relevant ketosis (≥2 mmol/L beta-hydroxybutyrate) was compared with and without inclusion of breast milk into standard KD. Ketosis, nutritional intakes, effectiveness, adverse effects, and successful continuation of breastfeeding were evaluated. Results: A total of 79 infants were eligible for analysis. In 20% (16), breast milk was included. Infants with breast milk included into the KD achieved relevant ketosis in 47 hours (interquartile range [IQR] 24-95) compared with 41 hours (IQR 22-70; p = 0.779) in infants with standard KD. Beta-hydroxybutyrate at day 2 was 3.1 mmol/L (IQR 0.5-4.9) and 3.8 mmol/L (IQR 2.2-4.9). Infants with breast milk included received higher amounts of carbohydrates at baseline and calories at 3 months. Seizure freedom and adverse effects showed no relevant differences. No infections occurred in infants receiving breast milk. In two infants, KD was initiated with breast-feds after bottle-feeding KD formula. In 31%, breastfeeding was continued after the KD, and in 25%, inclusion of breast milk and breastfeeding was maintained until complete weaning. Before discharge from hospital, the amount of breast milk included was median 90 mL/day (IQR 53-203) equivalent to median 9% (IQR 6-15). Conclusions: Appropriate ketosis was achieved in most infants and maintained within 48 hours. Incorporation of breast milk into KD is feasible, safe, and effective.
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Affiliation(s)
- Anastasia Dressler
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Chiara Häfele
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Franz Benninger
- Department of Child and Adolescent Neuropsychiatry, Medical University Vienna, Vienna, Austria
| | | | - Gudrun Gröppel
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Sharon Samueli
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Martha Feucht
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Christoph Male
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Andreas Repa
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
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Jones JE, Asato MR, Brown MG, Doss JL, Felton EA, Kearney JA, Talos D, Dacks PA, Whittemore V, Poduri A. Epilepsy Benchmarks Area IV: Limit or Prevent Adverse Consequence of Seizures and Their Treatment Across the Life Span. Epilepsy Curr 2020; 20:31S-39S. [PMID: 31973592 PMCID: PMC7031803 DOI: 10.1177/1535759719895277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Epilepsy represents a complex spectrum disorder, with patients sharing seizures as a common symptom and manifesting a broad array of additional clinical phenotypes. To understand this disorder and treat individuals who live with epilepsy, it is important not only to identify pathogenic mechanisms underlying epilepsy but also to understand their relationships with other health-related factors. Benchmarks Area IV focuses on the impact of seizures and their treatment on quality of life, development, cognitive function, and other aspects and comorbidities that often affect individuals with epilepsy. Included in this review is a discussion on sudden unexpected death in epilepsy and other causes of mortality, a major area of research focus with still many unanswered questions. We also draw attention to special populations, such as individuals with nonepileptic seizures and pregnant women and their offspring. In this study, we review the progress made in these areas since the 2016 review of the Benchmarks Area IV and discuss challenges and opportunities for future study.
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Affiliation(s)
- Jana E Jones
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Miya R Asato
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, PA, USA
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Elizabeth A Felton
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | | | - Delia Talos
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Vicky Whittemore
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MA, USA.,Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Campbell C, Cavalleri GL, Delanty N. Exploring the genetic overlap between psychiatric illness and epilepsy: A review. Epilepsy Behav 2020; 102:106669. [PMID: 31785486 DOI: 10.1016/j.yebeh.2019.106669] [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: 07/29/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
There is a long-documented epidemiological link between epilepsy and psychiatric disorders. People with epilepsy are at an increased risk for a variety of psychiatric illnesses, as are their family members, and people with epilepsy may experience psychiatric side effects because of their antiepileptic drugs (AEDs). In recent years, large-scale, collaborative international studies have begun to shed light on the role of genetic variation in both epilepsy and psychiatric illnesses, such as schizophrenia, depression, and anxiety. But so far, finding shared genetic links between epilepsy and psychiatric illness has proven surprisingly difficult. This review will discuss the prevalence of psychiatric comorbidities in epilepsy, recent advances in genetic research into both epilepsy and psychiatric illness, and the extent of our current knowledge of the genetic overlap between these two important neurobiological conditions.
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Affiliation(s)
- Ciarán Campbell
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Molecular and Cellular Therapeutics, RCSI Dublin, Ireland
| | - Gianpiero L Cavalleri
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Molecular and Cellular Therapeutics, RCSI Dublin, Ireland
| | - Norman Delanty
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Molecular and Cellular Therapeutics, RCSI Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland.
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Epilepsy and autoimmune diseases: Comorbidity in a national patient cohort. Seizure 2019; 75:89-95. [PMID: 31918165 DOI: 10.1016/j.seizure.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To examine if autoimmune disorders occur with an increased frequency in patients with epilepsy. An autoimmune etiology of epilepsies has been suggested. By using data from The Norwegian Prescription Database (NorPD) we have surveyed a national cohort of patients with active epilepsy treated with antiepileptic drugs. METHODS NorPD contains all prescriptions of drugs dispensed at pharmacies in Norway since 2004. We received data of all drugs prescribed January 2004 - June 2014 for patients receiving an antiepileptic drug.79 751 patients receiving at least two prescriptions of antiepileptic drugs with the reimbursement code for epilepsy were included. To examine autoimmune comorbidity, medications specific for autoimmune diseases were retrieved. Standardized Incidence Ratios (SIR) with 95 % confidence interval (CI) were used to determine whether the occurrence of the prescribed autoimmune drugs in the epilepsy group deviated from the general population. Subgroups stratified for sex and age were examined. RESULTS The epilepsy patients were more often treated with insulin and insulin analogs, SIR 1.8 (95 % CI 1.7-1.9); thyroid substitution, SIR 1.7 (95 % CI 1.7-1.8); pyridostigmine, SIR 1.5 (95 % CI 1.1-2.1); multiple sclerosis (MS) medications, SIR 4.9 (95 % CI 4.6-5.3); and immunosuppressive drugs SIR 1.2 (95 % CI 1.1-1.2). All epilepsy subgroups were more often than expected treated with thyroid substitution. CONCLUSIONS Based on a large, unselected patient cohort we find that epilepsy patients more often are prescribed medications used to treat type 1 diabetes mellitus, hypothyroidism, myasthenia gravis and MS. This was true for both men and women, and in most age-groups.
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Wang AD, Leong M, Johnstone B, Rayner G, Kalincik T, Roos I, Kwan P, O’Brien TJ, Velakoulis D, Malpas CB. Distinct psychopathology profiles in patients with epileptic seizures compared to non-epileptic psychogenic seizures. Epilepsy Res 2019; 158:106234. [DOI: 10.1016/j.eplepsyres.2019.106234] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 11/25/2022]
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Malpas CB, Wang AD, Leong M, Johnstone B, Rayner G, Kalincik T, Kwan P, O'Brien TJ, Velakoulis D. Abbreviated assessment of psychopathology in patients with suspected seizure disorders. Epilepsy Behav 2019; 100:106530. [PMID: 31665694 DOI: 10.1016/j.yebeh.2019.106530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/11/2019] [Accepted: 08/29/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE Psychopathology is common in patients undergoing investigation for seizure-related disorders. Psychometric examination using self-report instruments, such as the Symptom Checklist 90 - Revised (SCL-90-R), can assist diagnosis. The SCL-90-R, however, is a lengthy instrument and might not be tolerated by all patients. We assessed several abbreviated forms of the SCL-90-R in patients undergoing video encephalographic monitoring (VEM). METHOD Six hundred eighty-seven patients completed the SCL-90-R, and scores were computed for the full SCL-90-R and five abbreviated forms. Correlations and mean differences were computed between different forms. Classification accuracy was assessed via receiver operating characteristic (ROC) curves, and measurements models were examined using confirmatory factor analysis (CFA). RESULTS All abbreviated forms were strongly correlated with the SCL-90-R for general psychopathology (r = 0.93-0.99), depression (r = 0.89-0.95), anxiety (r = 0.97-0.98), psychosis (r = 0.95-0.99), and obsessive-compulsive symptoms (r = 0.97). Classification performance was similar across forms for depression and anxiety, with high negative predictive values (0.90-0.94) and lower positive predictive values (0.34-0.38). Classification performance for psychotic and obsessive-compulsive disorders was poor. Differences were observed between the full SCL-90-R and its abbreviated forms across most domains (d = 0.00-0.65). The published measurement model was most strongly validated for the SCL-27, SCL-14, and the SCL-K-9. CONCLUSIONS These five SCL-90-R abbreviated forms show high convergent validity with the full version. In patients undergoing investigation for seizure-related disorders, the Brief Symptom Inventory full form (BSI) or short form (BSI-18) is most appropriate where screening for both depression and anxiety is required. The SCL-K-9 is appropriate when only a single measure of global psychological distress is required. None of the instruments were able to detect psychotic or obsessive-compulsive symptoms with great accuracy. Caution should be exercised when making direct comparisons across the different forms.
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Affiliation(s)
- Charles B Malpas
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neurology, Alfred Hospital, Australia; Department of Neurosciences, Monash University, Australia.
| | - Albert D Wang
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Australia
| | - Michelle Leong
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Australia
| | - Benjamin Johnstone
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Australia
| | - Genevieve Rayner
- Department of Medicine (Austin Health), The University of Melbourne, Australia; Department of Neurology, Alfred Hospital, Australia; Department of Neurosciences, Monash University, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Tomas Kalincik
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia
| | - Patrick Kwan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neurology, Alfred Hospital, Australia; Department of Neurosciences, Monash University, Australia
| | - Terence J O'Brien
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neurology, Alfred Hospital, Australia; Department of Neurosciences, Monash University, Australia
| | - Dennis Velakoulis
- Department of Psychiatry, Royal Melbourne Hospital, Australia; Department of Psychiatry, The University of Melbourne, Australia
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Löscher W. Consequences of housing conditions and interindividual diversity in rodent models of acquired epilepsy. Epilepsia 2019; 60:2016-2019. [PMID: 31584191 DOI: 10.1111/epi.16344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/18/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
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Watson F, Packer RMA, Rusbridge C, Volk HA. Behavioural changes in dogs with idiopathic epilepsy. Vet Rec 2019; 186:93. [PMID: 31554714 DOI: 10.1136/vr.105222] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 07/28/2019] [Accepted: 08/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Breed-specific and broader cohort studies have shown behavioural changes in dogs following the onset of idiopathic epilepsy (IE). METHODS A cross-sectional, case-control questionnaire study was carried out to strengthen this body of evidence. Owners of eight breeds of dog completed an online questionnaire about their dogs' behaviour; once for control dogs and twice for dogs with IE, for both pre-IE and post-IE onset behaviour. RESULTS Ninety-six (24.74 per cent) dogs with IE and 292 (75.26 per cent) age and breed-matched control dogs met the inclusion criteria. Control dogs had significantly higher 'Trainability' scores than dogs with IE (P=0.04). After IE, dogs had significantly higher 'Dog-Directed Fear or Aggression' (P=0.02), 'Non-Social Fear' (P=0.01), 'Attachment/Attention-Seeking Behaviour' (P=0.04), 'Attention-Deficit' (P=0.02) and significantly lower 'Trainability' (P=0.02) than prior to the onset of IE. Medication status did not significantly affect any behavioural factor, but drug-resistant dogs had significantly less 'Trainability' than drug-responsive (P=0.04) and partially drug-responsive dogs (P=0.03). CONCLUSION Behavioural differences related to cognitive function are seen between dogs with IE and controls. Behavioural changes related to anxiety, attention and cognition are seen in dogs following the onset of IE. The ability to clinically define and diagnose behavioural comorbidities in dogs is much needed from both a clinical and research perspective.
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Affiliation(s)
- Fraje Watson
- Fitzpatrick Referrals Orthopaedics and Neurology, Godalming, UK .,Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, Hatfield, UK
| | | | - Clare Rusbridge
- Fitzpatrick Referrals Orthopaedics and Neurology, Godalming, UK.,School of Veterinary Medicine, University of Surrey, Guildford, Surrey, UK
| | - Holger Andreas Volk
- Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, Hatfield, UK.,Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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45
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Vancampfort D, Ward PB. Physical activity correlates across the lifespan in people with epilepsy: a systematic review. Disabil Rehabil 2019; 43:1359-1366. [PMID: 31536383 DOI: 10.1080/09638288.2019.1665113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Understanding barriers and facilitators of physical activity (PA) participation in people with epilepsy is an essential first step to enable development of targeted and effective interventions. This systematic review examined that PA correlates in people with epilepsy across the lifespan. MATERIAL AND METHODS Major electronic databases were searched from inception until 1 April 2019. Keywords included "physical activity" or "exercise" and "epilepsy". RESULTS Out of 31 correlates from 10 studies (n = 495, 5-72 years) no consistent (i.e., reported in four or more studies) correlates were identified. In children and adolescents, membership of a sports club was a facilitator for being physically active (confirmed in one study: 1/1), while lower maternal educational level was a barrier (1/1). In adults, the most reported barrier was the presence of depression (3/3), followed by trait anxiety (2/3), state anxiety (1/1), side effects of medication (1/1), and perceived stigma (1/1). No studies focusing on middle-aged and old age people with epilepsy were available. CONCLUSIONS The current review found that quantitative research about PA barriers and facilitators in people with epilepsy is still in its infancy, but PA participation is associated with a range of biological, social, and psychological factors which should be considered in rehabilitation programs.Implications for rehabilitationMany people living with epilepsy do not engage in physical activity on a regular basis.Children with epilepsy who are member of a sports club are more physically active.Depression, anxiety, and perceived stigma are important barriers for being active in adults with epilepsy.Side-effects of antiepilepstic drugs are a barrier for being active in adults with epilepsy.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, Australia
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46
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Somboon T, Grigg-Damberger MM, Foldvary-Schaefer N. Epilepsy and Sleep-Related Breathing Disturbances. Chest 2019; 156:172-181. [DOI: 10.1016/j.chest.2019.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/12/2019] [Accepted: 01/16/2019] [Indexed: 12/18/2022] Open
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Wang HJ, Tan G, Deng Y, He J, He YJ, Zhou D, Liu L. Prevalence and risk factors of depression and anxiety among patients with convulsive epilepsy in rural West China. Acta Neurol Scand 2018; 138:541-547. [PMID: 30125939 DOI: 10.1111/ane.13016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/25/2018] [Accepted: 08/06/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To explore the prevalence and risk factors of depression and anxiety in patients with convulsive epilepsy (PWE) in rural West China. METHODS PWE from rural West China were evaluated for depression and anxiety with the Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E; Chinese version) and the Generalized Anxiety Disorder-7 (GAD-7; Chinese version). We also assessed their quality of life using the Quality of Life in Epilepsy Inventory (QOLIE-31) and their level of social support using the Social Support Rating Scale (SSRS). We used logistic regression analysis to identify independent risk factors of depression and anxiety and analysis of variance (ANOVA) to investigate the association between quality of life and depression and anxiety. RESULTS Of the 458 PWE in our study, 33.4% have anxiety and 52.6% have depression. SSRS (P = 0.03) and seizure frequency (P = 0.007) are independent risk factors of anxiety, and annual income of the patients (P < 0.001) is an independent risk factor of depression. PWE with both depression and anxiety have significantly lower QOLIE-31 total and subtotal scores. CONCLUSIONS PWE have a high prevalence of depression and anxiety in rural West China, which may be impacting their quality of life. PWE with depression and anxiety got a worse quality of life, and depression had a greater impact on quality of life for PWE than anxiety. The risk factors of depression and anxiety include seizure frequency and social support, while annual income is an additional risk factor of depression. Identifying risk factors early may be helpful in the timely management of these symptoms.
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Affiliation(s)
- Hai-Jiao Wang
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Ge Tan
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Ying Deng
- Sichuan Center of Disease Control and Prevention; Chengdu Sichuan China
| | - Jun He
- Sichuan Center of Disease Control and Prevention; Chengdu Sichuan China
| | - Yu-Jin He
- Sichuan Center of Disease Control and Prevention; Chengdu Sichuan China
| | - Dong Zhou
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Ling Liu
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
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Fisher PL, Reilly J, Noble A. Metacognitive beliefs and illness perceptions are associated with emotional distress in people with epilepsy. Epilepsy Behav 2018; 86:9-14. [PMID: 30036766 DOI: 10.1016/j.yebeh.2018.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/05/2018] [Accepted: 07/08/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Emotional distress is common in people with epilepsy (PWE) for which efficacious interventions are required. Developing evidence-based treatments should be based on testable models of the psychological mechanisms maintaining psychopathology. The Self-Regulatory Executive Function (S-REF) model proposes that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. Although preliminary support exists for the role of metacognitive beliefs in emotional distress in PWE, their role has yet to be tested when controlling for the contribution made by illness perceptions. METHODS Four hundred and fifty-seven PWE completed an online survey, which assessed anxiety, depression, metacognitive beliefs, illness perceptions, general demographic factors, and epilepsy characteristics. RESULTS Hierarchical regression analyses demonstrated that metacognitive beliefs and illness perceptions were both associated with anxiety and depression when controlling for the influence of demographic variables and epilepsy characteristics. However, metacognitive beliefs accounted for more variance in anxiety and depression than illness perceptions. CONCLUSION Metacognitive beliefs appear to make a greater contribution to anxiety and depression in PWE than illness perceptions. Prospective studies are now needed to establish the causal role of metacognitive beliefs in both the development and persistence of emotional distress.
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Affiliation(s)
- Peter L Fisher
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - James Reilly
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - Adam Noble
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
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Mwangala PN, Kariuki SM, Nyongesa MK, Mwangi P, Chongwo E, Newton CR, Abubakar A. Cognition, mood and quality-of-life outcomes among low literacy adults living with epilepsy in rural Kenya: A preliminary study. Epilepsy Behav 2018; 85:45-51. [PMID: 29908383 PMCID: PMC6086937 DOI: 10.1016/j.yebeh.2018.05.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 12/25/2022]
Abstract
Epilepsy is frequently associated with neurocognitive impairments, mental health, and psychosocial problems but these are rarely documented in low- and middle-income countries. The aim of this study was to examine the neurocognitive outcomes, depressive symptoms, and psychosocial adjustments of people with epilepsy (PWE) in Kilifi, Kenya. We evaluated the impact of these outcomes on health-related quality of life. Self-report, interviewer-administered measures of depression (Major Depression Inventory) and quality of life (RAND SF-36) were administered to 63 PWE and 83 community controls. Neurocognitive functioning was assessed using Raven's Standard Progressive Matrices, Digit Span, and Contingency Naming Test. The results show that PWE have poorer scores for executive function, working memory, intelligence quotient (IQ), depression, and quality of life than controls. Twenty-seven (27%) of PWE had depressive symptoms, which was significantly greater than in controls (6%); P < 0.001. Quality-of-life scores were significantly lower in PWE with depressive symptoms than in those without depressive symptoms (Mean QoL scores (standard deviation (SD)): 46.43 (13.27) versus 64.18 (17.69); P = 0.01. On adjusted linear regression models, depression affected total quality-of-life scores (P = 0.07) as well as individual health indicator domains touching on pain (P = 0.04), lethargy/fatigue (P = 0.01), and emotional well-being (P = 0.02). Our results show that epilepsy is associated with a significant burden of mental health and neurocognitive impairments in the community; however, community-based studies are needed to provide precise estimates of these disorders.
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Affiliation(s)
- Patrick N. Mwangala
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya,Corresponding author at: Center for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, 80108 Kilifi, Kenya.
| | - Symon M. Kariuki
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Moses K. Nyongesa
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Paul Mwangi
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Esther Chongwo
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya,Department of Public Health, Pwani University, Kilifi, Kenya
| | - Charles R. Newton
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya,Department of Public Health, Pwani University, Kilifi, Kenya,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya,Department of Public Health, Pwani University, Kilifi, Kenya,Department of Psychiatry, University of Oxford, Oxford, UK
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50
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Progressive exhaustion: A qualitative study on the experiences of Iranian family caregivers regarding patients undergoing hemodialysis. Int J Nurs Sci 2018; 5:193-200. [PMID: 31406824 PMCID: PMC6626230 DOI: 10.1016/j.ijnss.2018.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/29/2017] [Accepted: 01/11/2018] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the burden of care for patients undergoing hemodialysis from the experiences of family caregivers. Methods In this qualitative study, a content analysis approach was used for data collection and analysis. Participants were 16 family caregivers selected through purposive sampling from four medical education centers affiliated with Ahvaz Jundishapur University of Medical Sciences, Iran. Semi-structured interviews were held to collect data. Results Four categories were developed as follows: ‘care challenges’, ‘psychological vulnerabilities’, ‘the chronic nature of care ’and “care in the shade”. The categories led to the development of the main theme of ‘progressive exhaustion’ experienced by the family caregivers during the provision of care to patients undergoing hemodialysis. Conclusion Family caregivers have a significant role in the process of patient care, and this role leads them to progressive exhaustion; therefore, the overall health of the caregivers should be taken into account and more attention should be paid to their quality of life, social welfare, and satisfaction level.
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