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Khalid Z, Momotaz H, Briggs F, Cassidy KA, Chaytor NS, Fraser RT, Janevic MR, Jobst B, Johnson EK, Scal P, Spruill TM, Wilson BK, Sajatovic M. Depressive Symptoms in Older versus Younger People with Epilepsy: Findings from an Integrated Epilepsy Self-Management Clinical Research Dataset. J Multidiscip Healthc 2019; 12:981-988. [PMID: 31839708 PMCID: PMC6904884 DOI: 10.2147/jmdh.s227184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/01/2019] [Indexed: 12/04/2022] Open
Abstract
Aim There are limited data on psychological outcomes in older people with epilepsy (PWE). This analysis, from a large pooled dataset of clinical studies from the Managing Epilepsy Well (MEW) Network, examined clinical variables including depressive symptom severity, quality of life and epilepsy self-management competency among older (age 55+) vs younger (<age 55) PWE. We were particularly interested in differences between older vs younger individuals with clinically significant depression. Methods Analyses used baseline data from 9 MEW Network studies and examined demographic and clinical variables. Older vs younger individuals were compared and then we assessed groups with clinically significant depression vs those without clinically significant depression using the PHQ-9 and QOLIE-10 as a measure of quality of life. Results The sample included 935 individuals. Compared to younger adults (n=774), the older group (n=161) had a better quality of life (p= 0.041) and more individuals without clinically significant depression (p=0.038). There was a trend for slightly lower depression severity scores (PHQ-9 total) (p=0.07) in the older group and a trend for fewer seizures (p=0.055) in older adults relative to younger adults. Conclusion Compared to younger PWE, older PWE have less clinically significant depression and better quality of life. Future research needs to identify possible mechanisms underlying these differences.
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Affiliation(s)
- Zaira Khalid
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center , Cleveland, OH, USA
| | - Hasina Momotaz
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Farren Briggs
- Department of Population Health and Quantitative Science, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kristin A Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center , Cleveland, OH, USA.,Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Naomi S Chaytor
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Robert T Fraser
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Mary R Janevic
- Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Barbara Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
| | - Erica K Johnson
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Peter Scal
- Department of Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN, USA
| | - Tanya M Spruill
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Betsy K Wilson
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center , Cleveland, OH, USA.,Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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May TW, Pfäfflin M, Brandt C, Füratsch N, Schmitz B, Wandschneider B, Kretz R, Runge U, Geithner J, Karakizlis H, Rosenow F, Kerling F, Stefan H. Epilepsy in the elderly: restrictions, fears, and quality of life. Acta Neurol Scand 2015; 131:176-86. [PMID: 25312985 DOI: 10.1111/ane.12317] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Due to demographic change and high incidence of epilepsy in elderly, the number of elderly with epilepsies is increasing. However, only few studies investigated the impact of epilepsy on quality of life (QoL). We investigated how epilepsy affects different aspects of QoL dependent on the age of the patients and the age of onset of epilepsy. MATERIALS AND METHODS In a multicenter, cross-sectional study, three patient groups were recruited from five centers: Group A1: 45 elderly (≥65 years.) with late onset of epilepsy (≥65 years), group A2: 51 elderly (≥65 years.) with early-onset, long-lasting epilepsy (≤50 years), group B: 41 young adults (≤50 years) with epilepsy. Statistical analysis of differences between groups was performed using generalized linear models. RESULTS Elderly with late-onset epilepsy (group A1) had a significantly lower seizure frequency, were treated with less anti-epileptic drugs (AEDs), and reported a better tolerability of AED treatment, but had more comorbidities compared with groups A2 and B. After adjusting for seizure frequency, tolerability of AEDs and comorbidity, young adults (group B) reported the highest overall QoL, whereas patients of group A1 and A2 did not differ significantly. Epilepsy-related fears, especially fears of stigmatization, were significantly higher in elderly with long-lasting epilepsy compared with groups A1 and B. CONCLUSION Seizure-related variables, tolerability of AEDs and comorbidity have a stronger impact on QoL and on restrictions due to epilepsy than age, age at onset of epilepsy or duration of epilepsy. However, some results indicate group-specific patterns of impairment and epilepsy-related fears.
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Affiliation(s)
- T. W. May
- Epilepsy Center Bethel; Society for Epilepsy Research; Bielefeld Germany
| | - M. Pfäfflin
- Epilepsy Center Bethel; Society for Epilepsy Research; Bielefeld Germany
| | - C. Brandt
- Epilepsy Center Bethel; Society for Epilepsy Research; Bielefeld Germany
| | - N. Füratsch
- Epilepsy Center Berlin-Brandenburg; Berlin Germany
| | - B. Schmitz
- Vivantes Humboldt-Klinikum; Berlin Germany
| | | | - R. Kretz
- Charité; Neurological Clinic; Berlin Germany
| | - U. Runge
- Neurological Clinic; University Hospital Greifswald; Greifswald Germany
| | - J. Geithner
- Neurological Clinic; University Hospital Greifswald; Greifswald Germany
| | - H. Karakizlis
- Epilepsy Center; Neurological Clinic; University Hospital Marburg; Marburg Germany
| | - F. Rosenow
- Epilepsy Center; Neurological Clinic; University Hospital Marburg; Marburg Germany
| | - F. Kerling
- Department of Neurology; Rummelsberg Hospital; Schwarzenbruck Germany
| | - H. Stefan
- Neurological Clinic; University Hospital Erlangen; Erlangen Germany
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5
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Saetre E, Abdelnoor M, Perucca E, Taubøll E, Isojärvi J, Gjerstad L. Antiepileptic drugs and quality of life in the elderly: results from a randomized double-blind trial of carbamazepine and lamotrigine in patients with onset of epilepsy in old age. Epilepsy Behav 2010; 17:395-401. [PMID: 20149756 DOI: 10.1016/j.yebeh.2009.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 12/28/2009] [Accepted: 12/29/2009] [Indexed: 11/18/2022]
Abstract
During an international double-blind trial evaluating the efficacy and tolerability of lamotrigine and carbamazepine in patients aged >or=65 with newly diagnosed epilepsy, the comparative effects of the drugs on health-related quality of life were investigated based on screening and 12-, 28-, and 40-week data, using the modified Side Effect and Life Satisfaction (SEALS) Inventory and the Liverpool Adverse Event Profile. Of 167 patients, 29 discontinued before first follow-up, and data were incomplete for 13. In 125 eligible subjects (62 taking carbamazepine, 63 taking lamotrigine), comparable baseline data did not change significantly during medication, within or across treatments. A borderline difference in the SEALS Dysphoria subscores favored lamotrigine. No difference between completers and noncompleters was identified. Twelve-week data for noncompleters were comparable across treatments. Changes in the inventories up to 40 weeks correlated moderately. Neither lamotrigine nor carbamazepine seems likely to cause significant changes in health-related quality of life measures after 40 weeks at therapeutic doses.
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Affiliation(s)
- Erik Saetre
- Department of Neuro Habilitation, Oslo University Hospital Ullevaal, 0407 Oslo, Norway.
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8
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Canuet L, Ishii R, Iwase M, Ikezawa K, Kurimoto R, Azechi M, Takahashi H, Nakahachi T, Teshima Y, Takeda M. Factors associated with impaired quality of life in younger and older adults with epilepsy. Epilepsy Res 2009; 83:58-65. [DOI: 10.1016/j.eplepsyres.2008.09.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 09/09/2008] [Accepted: 09/14/2008] [Indexed: 10/21/2022]
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9
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Stefan H, Hubbertz L, Peglau I, Berrouschot J, Kasper B, Schreiner A, Krimmer J, Schauble B. Epilepsy outcomes in elderly treated with topiramate. Acta Neurol Scand 2008; 118:164-74. [PMID: 18384458 DOI: 10.1111/j.1600-0404.2008.01018.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore effectiveness, tolerability and quality of life in elderly patients with epilepsy treated with topiramate. METHODS One year, open-label, flexible-dosing clinical trial. RESULTS One hundred and seven patients (mean age 69 years, 53% men) were studied during 273 +/- 141 days. The average final dose in monotherapy was 98 mg/day vs 153 mg/day in adjunctive treatment. Mean monthly cumulative seizure frequency decreased from 3.7 +/- 15 to 1.6 +/- 7.7 (n = 101, P < 0.0001), 78% of patients with seizures at baseline (n = 102) achieved at least 50% reduction in seizure frequency, 44% were seizure-free throughout the trial. Total scores on the quality of life in epilepsy inventory (QOLIE-31) improved from 57 +/- 17 to 68 +/- 18 (n = 64, P < 0.0001). The most frequently reported adverse events included convulsions, dizziness and tiredness. CONCLUSIONS Elderly patients treated with topiramate showed marked reductions in seizures, good tolerability and significant improvements in several aspects of quality of life.
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Affiliation(s)
- H Stefan
- Epilepsy Center, University of Erlangen, Germany
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10
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Laccheo I, Ablah E, Heinrichs R, Sadler T, Baade L, Liow K. Assessment of quality of life among the elderly with epilepsy. Epilepsy Behav 2008; 12:257-61. [PMID: 17988950 DOI: 10.1016/j.yebeh.2007.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 08/28/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
Abstract
As the elderly represent the most rapidly growing population in the United States, it is critical that physicians are capable of managing their chronic illnesses, including epilepsy. Optimal treatment of epilepsy integrates an understanding of health-related quality of life (HRQOL), yet limited information is available to guide HRQOL issues among the elderly. This study found that seniors with epilepsy do not have poorer HRQOL compared with general epilepsy populations. However, when compared with general populations without epilepsy, seniors with epilepsy report a significantly lower HRQOL across all domains. Multiple factors may uniquely affect HRQOL among elderly populations with epilepsy: aging, comorbid conditions, and epilepsy variables. However, to our knowledge, no one instrument addresses all of these aspects. The development of HRQOL instruments specifically for an elderly population with epilepsy may be useful and needed.
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Affiliation(s)
- Ikuko Laccheo
- University of Kansas School of Medicine-Wichita, Wichita, KS 67214-3199, USA
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Kuo HT, Tsai MY, Peng CT, Wu KH. Pilot study on the "quality of life" as reflected by psychosocial adjustment of children with thalassemia major undergoing iron-chelating treatment in western Taiwan. Hemoglobin 2006; 30:291-9. [PMID: 16798654 DOI: 10.1080/03630260600642641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Comprehensive care for thalassemia major (TM) patients has achieved great advances in the world, yet psychosocial developmental aspects of care in families with afflicted members has made only limited progress. Besides confronting the disease itself, a major task for children with TM is to develop into autonomous, healthy, and functioning adults. An emerging concept in considering the adjustment of children with chronic physical disorders is "quality of life"(QL). To study the QL with regard to reflection by psychosocial adjustment in TM children, we enrolled 55 TM patients undergoing intravenous (IV) and/or oral iron chelation, 39 of whom completed the content on issues related to QL according to Cramer and Devinsky. It was concluded that oral iron chelation can be better adjusted than IV iron chelation for a thalassemic child. This favors its use, but not necessarily in combination with IV iron chelation. Perception gaps that arise from age or generation merit concern. This approach to the study of QL, as reflected by psychosocial adjustment in children with TM, is an excellent method for learning about parental-child adjustment regarding a chronic physical condition such as TM.
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Affiliation(s)
- Huang-Tsung Kuo
- Department of Developmental and Behavioral Pediatrics, Taichung, Taiwan.
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Schachter SC. Quality of life for patients with epilepsy is determined by more than seizure control: the role of psychosocial factors. Expert Rev Neurother 2006; 6:111-8. [PMID: 16466318 DOI: 10.1586/14737175.6.1.111] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antiepileptic drugs remain the cornerstone of epilepsy treatment for minimizing, if not eliminating, seizures. However, many factors other than the degree of seizure control influence the quality of life for patients with epilepsy. This review focuses on psychosocial factors that have been associated with quality of life in this population, especially mood disorders, stigma seizure worry, self-esteem and self-mastery. Irrespective of their level of seizure control from antiepileptic drugs, patients may also benefit from targeted psychosocial interventions that reduce the negative impact of these factors on their quality of life.
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