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Kamitaki BK, Maniar S, Rambhatla R, Gao K, Cantor JC, Choi H, Bover Manderski MT. Health insurance and transportation barriers impact access to epilepsy care in the United States. Epilepsy Res 2024; 205:107424. [PMID: 39121695 DOI: 10.1016/j.eplepsyres.2024.107424] [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: 04/29/2024] [Revised: 06/25/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Inconsistent access to healthcare for people with epilepsy results in reduced adherence to antiseizure medications, increased seizure frequency, and fewer appropriate referrals for epilepsy surgery. Identifying and addressing factors that impede access to care should consequently improve patient outcomes. We hypothesized that health insurance and transportation affect access to outpatient neurology care for adults living with epilepsy in the United States (US). METHODS We conducted a retrospective cross-sectional study of US adults with active epilepsy surveyed via the National Health Interview Survey (NHIS) in 2015 and 2017. We established whether patients reported seeing a neurologist in the past year and used multiple logistic regression to determine whether health insurance status and transportation access were associated with this outcome. RESULTS We identified 735 respondents from 2015 and 2017, representing an estimated 2.98 million US adults with active epilepsy. After adjusting for socioeconomic and seizure-related co-variates, we found that a lack of health insurance coverage was associated with no epilepsy care in the past year (adjusted odds ratio [aOR] 0.22; 95 % confidence interval [CI]: 0.09 - 0.54). Delayed care due to inadequate transportation (aOR 0.42; 95 % CI: 0.19 - 0.93) also resulted in reduced patient access to a neurologist. CONCLUSION Due to the inherent nature of their condition, people with epilepsy are less likely to have employer-sponsored health insurance or consistent driving privileges. Yet, these factors also impact patient access to neurological care. We must address transportation and insurance barriers through long-term investment and partnership between community, healthcare, and government stakeholders.
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Affiliation(s)
- Brad K Kamitaki
- Rutgers-Robert Wood Johnson Medical School, Department of Neurology, 125 Paterson Street, Suite 6200, New Brunswick, NJ 08901, USA.
| | - Shelly Maniar
- Rutgers-Robert Wood Johnson Medical School, Department of Neurology, 125 Paterson Street, Suite 6200, New Brunswick, NJ 08901, USA.
| | - Raaga Rambhatla
- Rutgers-Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Kelly Gao
- Rutgers-Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Joel C Cantor
- Rutgers University, Center for State Health Policy, 112 Paterson Street, 5th Floor, New Brunswick, NJ 08901, USA.
| | - Hyunmi Choi
- Columbia University, Department of Neurology, 710 West 168th Street, 7th Floor, New York, NY 10032, USA.
| | - Michelle T Bover Manderski
- Rutgers School of Public Health, Department of Biostatistics and Epidemiology, 683 Hoes Lanes West, Piscataway, NJ 08854, USA; Rutgers Institute for Nicotine and Tobacco Studies, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA.
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Malmgren K. Patient-centered outcomes and quality of life in elderly people with epilepsy: A focused review. Seizure 2024:S1059-1311(24)00191-2. [PMID: 38945798 DOI: 10.1016/j.seizure.2024.06.025] [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: 04/04/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/02/2024] Open
Abstract
The highly heterogeneous population of elderly with epilepsy continues to increase as the incidence of epilepsy rises with increasing life expectancy. There are many aspects to consider in the treatment of elderly with epilepsy, e g comorbidities and the complexity of polypharmacy. The literature on quality-of-life (QoL) and patient-centered outcomes in elderly in general as well as in elderly with epilepsy is limited, most of the existing studies report results from quality-of-life surveys. No such QoL questionnaires have, however, in the validation process explored issues specific to the elderly. Seizure frequency, co-morbidities and depression predicted QoL in elderly with epilepsy and the energy/fatigue domain scored worst when QOLIE-31 was used. In the handful of qualitative interview studies identified in this review, a number of topics specific for elderly with epilepsy were explored. Some of these were difficulties with information gathering, the importance of maintaining normalcy, incongruence with provider goals and wanting to be more involved in the treatment. There is a need for further exploration of the specific concerns of elderly with epilepsy. This review provides a comprehensive overview of the studies and emphasizes the importance of involving elderly people with epilepsy in their own care.
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Affiliation(s)
- Kristina Malmgren
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Lalatović S, Smiljanić I, Ristić AJ, Čvorović Đ, Golubović V, Parojčić A, Baščarević V, Krstić N, Milovanović M. Psychometric evaluation of the Serbian version of the Stigma Scale of Epilepsy (SSE). Epilepsy Behav 2023; 149:109520. [PMID: 37944288 DOI: 10.1016/j.yebeh.2023.109520] [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: 07/22/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the psychometric properties of the Serbian-language version of the Stigma Scale of Epilepsy (SSE). METHODS The sample consisted of 108 patients with epilepsy (PWE) (60.2 % were female, age range: 19-67 years) and 102 students (86.3 % were female, age range: 18-47 years). The study encompassed two phases: (1) translation of the SSE into Serbian using the back-translation technique, and (2) evaluation of reliability and construct validity of the Serbian-language version of SSE. In addition to the SSE, the PWE filled out a Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). The socio-demographic and clinical variables were noted for each patient by the semistructured interview. Besides completing the SSE, the students were asked if they knew anyone with epilepsy. The reliability of the questionnaire was tested by assessing the internal consistency of the scale (Cronbach's α), while construct validity was assessed by factor analysis, method of known-groups validation, and correlation analysis. RESULTS SSE demonstrates a satisfactory level of reliability in both samples, with Cronbach's α of 0.86 in the PWE sample and 0.90 in the student sample. Using exploratory factor analysis, four factors were identified in both samples, corresponding relatively well with the scale domains originally produced, with a few exceptions described. Adverse effects (AEs) of antiseizure medications (ASMs) and driving ability significantly influenced SSE scores, but there were no significant effects of other socio-demographic and clinical variables on epilepsy-related stigma in the PWE sample. In addition, depression severity significantly influenced SSE scores (based on NDDI-E cut-off score), with the SSE showing a positive association with PHQ-9 (r = 0.42, p < .001) and GAD-7 (r = 0.35, p < .001) as well. Regarding the student sample, the effects of personal knowledge of someone with epilepsy on SSE scores were found to be significant. Besides, students (M = 46.28, SD = 16.43) reported higher epilepsy-related stigma than patients (M = 40.66, SD = 17.01), t(208) = 2.43, p < .05, d = 0.34. CONCLUSION The Serbian version of the SSE has good psychometric properties and represents a useful tool for assessing epilepsy-related stigma in both patients and the general population.
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Affiliation(s)
- Staša Lalatović
- Faculty of Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, 11000 Belgrade, Serbia
| | - Isidora Smiljanić
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia
| | - Aleksandar J Ristić
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia; Neurology Clinic, University Clinical Center of Serbia, Dr Subotića 6, 11000 Belgrade, Serbia
| | - Đurđica Čvorović
- Department for Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Milana Kašanina 3, 11000 Belgrade, Serbia
| | - Violeta Golubović
- Department for Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Milana Kašanina 3, 11000 Belgrade, Serbia
| | - Aleksandra Parojčić
- Department for Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Milana Kašanina 3, 11000 Belgrade, Serbia
| | - Vladimir Baščarević
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia; Neurosurgery Clinic, University Clinical Center of Serbia, Koste Todorovića 4, 11000 Belgrade, Serbia
| | - Nadežda Krstić
- Faculty of Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, 11000 Belgrade, Serbia
| | - Maja Milovanović
- Faculty of Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, 11000 Belgrade, Serbia; Department for Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Milana Kašanina 3, 11000 Belgrade, Serbia.
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Aljumah TK, Al-Attas AA, Alqahtani AA, Masuadi EM, Aldahi AS, Alshammari MA, Heji AT, Alanazi A. Sudden unexpected death in epilepsy: What Saudi people with epilepsy want to know-A cross-sectional study. Epileptic Disord 2023; 25:528-533. [PMID: 37202837 DOI: 10.1002/epd2.20079] [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: 01/21/2023] [Revised: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) is a significant cause of mortality in people with epilepsy (PWE), with an incidence of 1 per 1000 members of the population. In Saudi Arabia, no data are available that inform local clinical practitioners about the attitudes of PWE regarding SUDEP. The aim of this study was to investigate the perspectives of Saudi PWE toward SUDEP and to assess their knowledge of SUDEP. METHODS A cross-sectional questionnaire-based study was conducted at the neurology clinics of King Abdul-Aziz Medical City, Riyadh and Prince Sultan Military Medical City, Riyadh. RESULTS Of the 377 patients who met the inclusion criteria, 325 completed the questionnaire. The mean age of the respondents was 32.9 ± 12.6 years. Of the study subjects, 50.5% were male. Only 41 patients (12.6%) had heard about SUDEP. Most patients (94.5%) wanted to know about SUDEP, of whom 313 (96.3%) wanted to receive this information from a neurologist. A total of 148 patients (45.5%) thought that the appropriate time to receive information about SUDEP was after the second visit, whereas only 75 (23.1%) wanted to learn about SUDEP during the first visit. However, 69 patients (21.2%) thought that the appropriate time to be informed about SUDEP was when seizure control had become more difficult. Almost half (172, 52.9%) of the patients thought that SUDEP could be prevented. SIGNIFICANCE Our findings suggest that most Saudi PWE do not know about SUDEP and want to be counseled about their risk of SUDEP by their physicians. Therefore, education of Saudi PWE about SUDEP must be improved.
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Affiliation(s)
- Talal K Aljumah
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Ahmed A Alqahtani
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Emad M Masuadi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed S Aldahi
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed A Alshammari
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Alaa T Heji
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali Alanazi
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Kang W. People with epilepsy have poor life satisfaction and self-rated health: Findings from the United Kingdom. Front Psychol 2023; 13:986520. [PMID: 36733876 PMCID: PMC9888241 DOI: 10.3389/fpsyg.2022.986520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/22/2022] [Indexed: 01/18/2023] Open
Abstract
Epilepsy is a neurological disorder characterized by brief, recurrent disturbances in the normal electrical functions of the brain that result in seizures. Although epilepsy is closely related to wellbeing, much less is known about how life satisfaction and SRH are affected by epilepsy in a nationally representative sample from the United Kingdom. The current research aims to investigate the difference in life satisfaction and SRH between people with epilepsy and people without epilepsy by using an innovative train-and-test approach on data collected between 2009 and 2010 from 428 people with epilepsy and 39,024 healthy controls while taking demographics into account. The results showed that people with epilepsy have both poorer life satisfaction and SRH compared to the scores that would be predicted by their demographics. This study implies that both life satisfaction and SRH are valid measures of wellbeing in people with epilepsy. Health professionals may utilize findings from the current study to come up with ways that can benefit wellbeing of people with epilepsy.
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6
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Epilepsy in Older Persons. Neurol Clin 2022; 40:891-905. [DOI: 10.1016/j.ncl.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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The effects of low bone mineral density on pain, quality of life and fatigue in patients with epilepsy. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.1009016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Schwab C, Wadle NE, Knake S, von Podewils F, Siebenbrodt K, Kohlhase K, Schulz J, Menzler K, Mann C, Rosenow F, Seifart C, Strzelczyk A. Patients' knowledge about epilepsy-related risks, morbidity, and mortality: A multicenter cohort study from Germany. Epilepsy Behav 2021; 124:108343. [PMID: 34619541 DOI: 10.1016/j.yebeh.2021.108343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Patient education is a central component of quality care. Enhancing patient knowledge can improve patients' quality of life and facilitate successful self-management. We sought to identify patients' knowledge levels and knowledge gaps regarding epilepsy-related risks, morbidity, and mortality. METHODS Adult patients with epilepsy presenting to the university hospitals in Frankfurt, Greifswald, and Marburg between February 2018 and May 2020 were asked to participate in this questionnaire-based study. RESULTS A total of 238 patients (52% women), with a mean age of 39.2 years (range: 18-77 years), participated in this study. Spontaneously, the majority of patients (51.3%) named driving a car, and other traffic-related accidents as possible causes of morbidity and mortality, and 23.9% of patients reported various causes of premature death, such as suffocation, drowning, and respiratory or cardiac arrest due to seizures. Falls due to epilepsy (19.7%) and injuries in general (17.6%) were named as further causes of morbidity and mortality. The vast majority were aware that alcohol (87.4%), sleep deprivation (86.6%), and risky activities in daily life (80.3%) increased the risk of seizure occurrence or increased morbidity and mortality. Regarding overall mortality, 52.1% thought that people with epilepsy were at greater risk of premature death, whereas 46.2% denied this fact to be true. Only 29.4% were aware of status epilepticus, and 27.3% were aware of sudden unexpected death in epilepsy (SUDEP). Driving ability, working ability, and seizure risk were named as major or moderate concerns among patients, but the risk of premature mortality was not a major concern. One-quarter of all patients (26.9%) indicated that they were not counseled about any risk factors or causes of morbidity or mortality by their physicians. CONCLUSIONS A lack of knowledge concerning premature mortality, SUDEP, and status epilepticus exists among adult patients with epilepsy. A substantial number of patients indicated that these issues were not discussed adequately by their physicians.
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Affiliation(s)
- Christina Schwab
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Nora-Elena Wadle
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Felix von Podewils
- Epilepsy Center and Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Konstantin Kohlhase
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Juliane Schulz
- Epilepsy Center and Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Katja Menzler
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Carola Seifart
- Institutional Review Board, Medical Faculty, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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Samanta D, Ostendorf AP, Willis E, Singh R, Gedela S, Arya R, Scott Perry M. Underutilization of epilepsy surgery: Part I: A scoping review of barriers. Epilepsy Behav 2021; 117:107837. [PMID: 33610461 PMCID: PMC8035287 DOI: 10.1016/j.yebeh.2021.107837] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
One-third of persons with epilepsy have seizures despite appropriate medical therapy. Drug resistant epilepsy (DRE) is associated with neurocognitive and psychological decline, poor quality of life, increased risk of premature death, and greater economic burden. Epilepsy surgery is an effective and safe treatment for a subset of people with DRE but remains one of the most underutilized evidence-based treatments in modern medicine. The reasons for this quality gap are insufficiently understood. In this comprehensive review, we compile known significant barriers to epilepsy surgery, originating from both patient/family-related factors and physician/health system components. Important patient-related factors include individual and epilepsy characteristics which bias towards continued preferential use of poorly effective medications, as well as patient perspectives and misconceptions of surgical risks and benefits. Health system and physician-related barriers include demonstrable knowledge gaps among physicians, inadequate access to comprehensive epilepsy centers, complex presurgical evaluations, insufficient research, and socioeconomic bias when choosing appropriate surgical candidates.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Adam P Ostendorf
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Willis
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rani Singh
- Department of Pediatrics, Atrium Health/Levine Children's Hospital, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, USA
| | - Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Wojewodka G, McKinlay A, Ridsdale L. Best care for older people with epilepsy: A scoping review. Seizure 2021; 85:70-89. [PMID: 33450705 DOI: 10.1016/j.seizure.2020.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/28/2022] Open
Abstract
There are two peaks of diagnosis of epilepsy: in childhood and in people over 65. Older people may have complex needs like co-morbidity, polypharmacy, frailty, and social isolation. This scoping review focusses on the care of older people with epilepsy beyond diagnosis and medical treatment. We sought to identify areas within the UK health service needing development either in clinical practice or through further research. The search returned 4864 papers with 33 papers included in the review. The papers were grouped into psychosocial, self-management and services themes. Only one randomised controlled trial was found. Research was mainly based on cohort and case-control studies. Older people require more information to self-manage epilepsy and more psychological support to help with symptoms of anxiety and depression. People reported experiencing stigma and a reluctance to disclose their condition. This may increase the risk of isolation and difficulties in managing epilepsy. Studies reported that older people are referred less to neurologists, suggesting there may be a gap in care provision compared to younger people. Generalist health professionals may be better placed to provide holistic care, but they may need additional training to alleviate uncertainties in managing epilepsy. Care plans could help provide information, particularly for co-morbidity, but few had one. Our findings highlight psychological and self-management needs for managing epilepsy in older people. Health service staff may require upskilling to shift epilepsy management from neurologists to generalists. More research is needed regarding psychological and self-management interventions, particularly in the form of randomised controlled trials.
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Affiliation(s)
- Gabriella Wojewodka
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, 16 de Crespigny Park, PO Box 57, London, SE5 8AF, UK.
| | - Alison McKinlay
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, 16 de Crespigny Park, PO Box 57, London, SE5 8AF, UK
| | - Leone Ridsdale
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, 16 de Crespigny Park, PO Box 57, London, SE5 8AF, UK
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11
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Kluger BM, Drees C, Wodushek TR, Frey L, Strom L, Brown MG, Bainbridge JL, Fischer SN, Shrestha A, Spitz M. Would people living with epilepsy benefit from palliative care? Epilepsy Behav 2021; 114:107618. [PMID: 33246892 PMCID: PMC9326903 DOI: 10.1016/j.yebeh.2020.107618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022]
Abstract
Palliative care (PC) is an approach to the care of persons living with serious illness and their families that focuses on improving quality of life and reducing suffering by addressing complex medical symptoms, psychosocial needs, spiritual well-being, and advance care planning. While PC has traditionally been associated with hospice care for persons with cancer, there is now recognition that PC is relevant to many noncancer diagnoses, including neurologic illness, and at multiple points along the illness journey, not just end of life. Despite the recent growth of the field of neuropalliative care there has been scant attention paid to the relevance of PC principles in epilepsy or the potential for PC approaches to improve outcomes for persons living with epilepsy and their families. We believe this has been a significant oversight and that PC may provide a useful framework for addressing the many sources of suffering facing persons living with epilepsy, for engaging patients and families in challenging conversations, and to focus efforts to improve models of care for this population. In this manuscript we review areas of significant unmet needs where a PC approach may improve patient and family-centered outcomes, including complex symptom management, goals of care, advance care planning, psychosocial support for patient and family and spiritual well-being. When relevant we highlight areas where epilepsy patients may have unique PC needs compared to other patient populations and conclude with suggestions for future research, clinical, and educational efforts.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Cornelia Drees
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas R Wodushek
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Frey
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Strom
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacquelyn L Bainbridge
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah N Fischer
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Archana Shrestha
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark Spitz
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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12
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Epilepsy and aging. HANDBOOK OF CLINICAL NEUROLOGY 2020. [PMID: 31753149 DOI: 10.1016/b978-0-12-804766-8.00025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The intersection of epilepsy and aging has broad, significant implications. Substantial increases in seizures occur both in the elderly population, who are at a higher risk of developing new-onset epilepsy, and in those with chronic epilepsy who become aged. There are notable gaps in our understanding of aging and epilepsy at the basic and practical levels, which have important consequences. We are in the early stages of understanding the complex relationships between epilepsy and other age-related brain diseases such as stroke, dementia, traumatic brain injury (TBI), and cancer. Furthermore, the clinician must recognize that the presentation and treatment of epilepsy in the elderly are different from those of younger populations. Given the developing awareness of the problem and the capabilities of contemporary, multidisciplinary approaches to advance understanding about the biology of aging and epilepsy, it is reasonable to expect that we will unravel some of the intricacies of epilepsy in the elderly; it is also reasonable to expect that these gains will lead to further improvements in our understanding and treatment of epilepsy for all age groups.
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13
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Sen A, Jette N, Husain M, Sander JW. Epilepsy in older people. Lancet 2020; 395:735-748. [PMID: 32113502 DOI: 10.1016/s0140-6736(19)33064-8] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/23/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in older people, explore difficulties in establishing a diagnosis of epilepsy in this population, discuss appropriate antiseizure medications, and evaluate potential surgical treatment options. We consider cognitive, psychological, and psychosocial comorbidities and the effect that epilepsy might have on an older person's broader social or care network in high-income versus middle-income and low-income countries. We emphasise the need for clinical trials to be more inclusive of older people with epilepsy to help inform therapeutic decision making and discuss whether measures to improve vascular risk factors might be an important strategy to reduce the probability of developing epilepsy.
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Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Nathalie Jette
- Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Masud Husain
- Department of Psychology, University of Oxford, Oxford UK
| | - Josemir W Sander
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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Algahtani H, Shirah B, Algahtani R, Algahtani R. Epilepsy and driving: Local experience from Saudi Arabia. Epilepsy Behav 2019; 99:106401. [PMID: 31454705 DOI: 10.1016/j.yebeh.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The issue of epilepsy and driving has legal, social, and psychological implications. Many countries in the world restrict driving to people prone to epilepsy. There is no data from Saudi Arabia regarding the prevalence of driving among patients with epilepsy and their driving practices. In addition, to the best of our knowledge, there are no local laws or guidelines concerning driving for patients with epilepsy in Saudi Arabia. This study aimed to determine the prevalence of driving among male patients with epilepsy at King Abdulaziz Medical City in Jeddah, Saudi Arabia and determine the barriers and difficulties that they are suffering from especially when it comes to driving. METHODS This is a cross-sectional study that was conducted between July 2017 and June 2018 at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria of this study were male patients with epilepsy 18 years of age or above. The exclusion criteria were female patients at any age (since they were not allowed to drive at the time of the study) and male patients less than 18 years of age. This study utilized a self-made self-administered 25-item questionnaire. RESULTS A total of 182 surveys were distributed, and 164 individuals completed the survey (90.1% response rate). Most of the participants have a driving license (95.7%) and drive a car (98.8%). Almost all participants (99.4%) mentioned that nobody asked them whether they have epilepsy or not when issuing a driver's license. In addition, 94.5% were never told not to drive after the diagnosis of epilepsy. Regarding restrictions to driving, 98.7% reported that they drive at all times without any restrictions, and 92.7% reported that they drive both inside and outside the city. CONCLUSION This study showed that the number of male patients with epilepsy driving cars was extremely high, accounting for almost all the patients in this study, with most of them doing several wrong practices during driving. Other major issues include the lack of specific laws regulating driving for patients with epilepsy and no counseling from physicians about driving after the diagnosis of epilepsy. We recommend developing the Saudi driving regulations for patients with epilepsy, and this study is considered an urgent call for action for the formation of a local driving regulations taskforce. Health education about the risk of driving should be disseminated, especially for patients with uncontrolled epilepsy.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Bader Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raneem Algahtani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raghad Algahtani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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15
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Patel AD, Baca C, Franklin G, Herman ST, Hughes I, Meunier L, Moura LM, Munger Clary H, Parker-McFadden B, Pugh MJ, Schultz RJ, Spanaki MV, Bennett A, Josephson SA. Quality improvement in neurology. Neurology 2018; 91:829-836. [DOI: 10.1212/wnl.0000000000006425] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/25/2018] [Indexed: 11/15/2022] Open
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16
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Lekoubou A, Bishu KG, Ovbiagele B. Health care expenditures among elderly patients with epilepsy in the United States. Epilepsia 2018; 59:1433-1443. [DOI: 10.1111/epi.14455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Alain Lekoubou
- Department of Neurology; Medical University of South Carolina; Charleston SC USA
| | - Kinfe G. Bishu
- Department of Medicine; Medical University of South Carolina; Charleston SC USA
- Section of Health Systems Research and Policy; Medical University of South Carolina; Charleston SC USA
| | - Bruce Ovbiagele
- Department of Neurology; Medical University of South Carolina; Charleston SC USA
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17
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Willems LM, Watermann N, Richter S, Kay L, Hermsen AM, Knake S, Rosenow F, Strzelczyk A. Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study. Front Neurol 2018; 9:414. [PMID: 29963000 PMCID: PMC6013746 DOI: 10.3389/fneur.2018.00414] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/18/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: This study was designed to evaluate risk factors and incidence of epilepsy-related injuries and accidents (ERIA) at an outpatient clinic of a German epilepsy center providing healthcare to a mixed urban and rural population of over one million inhabitants. Methods: Data acquisition was performed between 10/2013 and 09/2014 using a validated patient questionnaire on socioeconomic status, course of epilepsy, quality of life (QoL), depression, injuries and accidents associated with seizures or inadequate periictal patterns of behavior concerning a period of 3 months. Univariate analysis, multiple testing and regression analysis were performed to identify possible variables associated with ERIA. Results: A total of 292 patients (mean age 40.8 years, range 18-86; 55% female) were enrolled and analyzed. Focal epilepsy was diagnosed in 75% of the patients. The majority was on an antiepileptic drug (AEDs) polytherapy (mean number of AEDs: 1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related injuries and accidents in a 3-month period. Besides lacerations (n = 18, 6.2%), abrasions and bruises (n = 9, 3.1%), fractures (n = 6, 2.2%) and burns (n = 3, 1.0%), 17 mild injuries (5.8%) were reported. In 20 (6.8% of the total cohort) cases, urgent medical treatment with hospitalization was necessary. Epilepsy-related injuries and accidents were related to active epilepsy, occurrence of generalized tonic-clonic seizures (GTCS) and drug-refractory course as well as reported ictal falls, ictal loss of consciousness and abnormal peri-ictal behavior in the medical history. In addition, patients with ERIA had significantly higher depression rates and lower QoL. Conclusion: ERIA and their consequences should be given more attention and standardized assessment for ERIA should be performed in every outpatient visit.
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Affiliation(s)
- Laurent M Willems
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Nina Watermann
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Saskia Richter
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Lara Kay
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Anke M Hermsen
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Knake
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
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18
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Epilepsy-related concerns among patients with epilepsy in West China. Epilepsy Behav 2018; 82:128-132. [PMID: 29625362 DOI: 10.1016/j.yebeh.2018.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/16/2018] [Accepted: 02/16/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE In the present study, we aimed to investigate patient-derived epilepsy-related concerns among Chinese individuals with epilepsy and the impact of seizure control on patient concerns. METHODS All adult patients with epilepsy who had visited the outpatient clinic at West China Hospital between July 2014 and June 2016 were invited to participate in the study. All patients were given a blank sheet of paper and asked to list any concerns they had regarding their disease in order of importance. Demographic and clinical characteristics were also evaluated while regression models were used to examine the impact of seizure control on patient concerns. RESULTS A total of 1040 patients reported 2202 concerns across 25 distinct categories. The most frequently listed concerns were worries about seizures (55.4%), maintaining a job (17.4%), and the heritability of epilepsy (16.0%). The legal right to drive was listed by only 3.5% of patients who took the survey while seizure recurrence was described by participants as the most important concern (379, 36.4%). Compared with the group with uncontrolled seizures, the group with controlled seizures reported less frequently about "holding down a job" (odds ratio (OR): 0.333 (0.187-0.591)), "fear of being injured during a seizure" (OR: 0.353 (0.183-0.682)), and "leading a normal life" (OR: 0.452 (0.234-0.871)), but they reported more frequently about "having another seizure" (OR: 2.447 (1.614-3.710)), "problems with medication side effects" (OR: 1.733 (1.148-2.616)), and their "legal right or ability to drive" (OR: 2.360 (1.094-5.092)). CONCLUSION Our findings indicated that Chinese adults with epilepsy had various concerns, some of which differed from those observed in Western populations. Concerns about heritability of seizures, marriage, and pregnancy were of greater concern to Chinese patients compared with Western patients while the legal right to drive appeared to be less of a concern to Chinese patients. Patients with controlled seizures may still have many concerns. Chinese physicians should monitor patient concerns even among those whose seizures remain controlled to meet their needs. More time and attention should be given to address these issues in clinical practice in the context of Chinese culture.
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Schoenberg MR, Rum RS, Osborn KE, Werz MA. A randomized, double-blind, placebo-controlled crossover study of the effects of levetiracetam on cognition, mood, and balance in healthy older adults. Epilepsia 2017; 58:1566-1574. [PMID: 28731266 DOI: 10.1111/epi.13849] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The cognitive and mood effects of levetiracetam (LEV) in older adults are not known. This study compared the cognitive and mood effects of LEV to placebo in healthy older adults. METHODS Cognitive, mood, and balance variables were compared between LEV and placebo using a randomized, double-blind, placebo-controlled crossover study with two 5-week treatment periods. Healthy volunteers (n = 20) aged 65-80 (mean age 72.4) received either LEV or placebo in which the LEV target dose was 1,000 mg/day. Volunteers, aged 65-80, were without epilepsy to limit potentially confounding the impact of seizures and/or underlying neuropathology on outcomes. LEV was initiated at 250 mg twice a day for 2 weeks, then increased to 500 mg twice a day for 2 weeks, and then tapered to 250 mg twice a day for 1 week. This was randomized with placebo for the two treatment arms. Measures included standardized neuropsychological, mood, and balance tests yielding 32 variables. Balance was assessed using subjective report (e.g., A-B neurotoxicity scale) and objective data (e.g., Berg Balance Scale). RESULTS Average LEV serum concentration was 16.9 (standard deviation [SD} 7.7). Repeated-measures analysis of variance (ANOVA) found no differences between LEV and placebo phases for 29 (90.6%) of 32 variables including no change in balance. Performance on LEV was better than placebo on a visual memory (MCG Complex Figure Recall; p = 0.007) and two attention tests (Trail Making Test, Part A, p = 0.009; Stroop Interference, p = 0.004). There was a trend for greater irritability and fatigue (POMS Anger and Fatigue) during the LEV phase (p = 0.029, p = 0.035). Effect-size changes were generally small (Cohen d < 0.5). SIGNIFICANCE LEV was well tolerated in this elderly population in terms of cognition, mood, and balance. When anticonvulsant medication is indicated for older adults, LEV has pharmacokinetic advantages, and these data indicate no adverse impact on cognition or balance.
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Affiliation(s)
- Mike R Schoenberg
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A.,Department of Neurology, University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A.,Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Ruba S Rum
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
| | - Katie E Osborn
- Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Mary Ann Werz
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa, U.S.A
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Yennadiou H, Wolverson E. The experience of epilepsy in later life: A qualitative exploration of illness representations. Epilepsy Behav 2017; 70:87-93. [PMID: 28411521 DOI: 10.1016/j.yebeh.2017.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/08/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study was to explore how older people living with epilepsy appraise their condition through their lived-experience. The common-sense model of illness representations (CSMIR) provides a framework to explain how individuals make sense of and manage health threats. Semi-structured in-depth interviews based on the CSMIR were conducted with ten people with epilepsy who were above the age of 65. The results were analyzed using Interpretative Phenomenological Analysis. Three overarching themes emerged from the analysis: 'the power of epilepsy', 'they say you can live a normal life but you can't' and 'attempts to adjust and cope'. Epilepsy was described as a threatening, persistent, and unpredictable condition associated with distressing experiences. Participants described a process of balancing negative psychosocial consequences including stigma, loss of control, and reliance on other people and medication with parallel co-existing coping strategies. These attempts to manage the condition were characterized by a desire for acceptance and increased awareness of epilepsy, strategies to restore loss of control, and strength derived from supportive relationships. We conclude that there is large scope for psychosocial interventions in healthcare provision for this patient group. The roles of specialist nursing, relationship-centered models, psychotherapy, educational, and self-management programs are highlighted.
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Affiliation(s)
- Haris Yennadiou
- The University of Hull, Faculty of Health and Social Care, Aire Building, Hull, Cottingham Road, Hull HU6 7RX, UK.
| | - Emma Wolverson
- The University of Hull, Faculty of Health and Social Care, Aire Building, Hull, Cottingham Road, Hull HU6 7RX, UK.
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21
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Meyer B, Weiss M, Holtkamp M, Arnold S, Brückner K, Schröder J, Scheibe F, Nestoriuc Y. Protocol for the ENCODE trial: evaluating a novel online depression intervention for persons with epilepsy. BMC Psychiatry 2017; 17:55. [PMID: 28173780 PMCID: PMC5297128 DOI: 10.1186/s12888-017-1229-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/04/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Depression is common among persons with epilepsy (PwE), affecting roughly one in three individuals, and its presence is associated with personal suffering, impaired quality of life, and worse prognosis. Despite the availability of effective treatments, depression is often overlooked and treated inadequately in PwE, in part because of assumed concerns over drug interactions or proconvulsant effects of antidepressants. Internet-administered psychological interventions might complement antidepressant medication or psychotherapy, and preliminary evidence suggests that they can be effective. However, no trial has yet examined whether an Internet intervention designed to meet the needs of PwE can achieve sustained reductions in depression and related symptoms, such as anxiety, when offered as adjunct to treatment as usual. METHODS/DESIGN This randomized controlled trial will include 200 participants with epilepsy and a current depressive disorder, along with currently at least moderately elevated depression (Patient Health Questionnaire (PHQ-9) sum score of at least 10). Patients will be recruited via epilepsy treatment centers and other sources, including Internet forums, newspaper articles, flyers, posters, and media articles or advertisements, in German-speaking countries. Main inclusion criteria are: self-reported diagnosis of epilepsy and a depressive disorder, as assessed with a phone-administered structured diagnostic interview, none or stable antidepressant medication, no current psychotherapy, no other major psychiatric disorder, no acute suicidality. Participants will be randomly assigned to either (1) a care-as-usual/waitlist (CAU/WL) control group, in which they receive CAU and are given access to the Internet intervention after 3 months (that is, a CAU/WL control group), or (2) a treatment group that may also use CAU and in addition immediately receives six-month access to the novel, Internet-administered intervention. The primary outcome measure is the PHQ-9, collected at three months post-baseline; secondary measures include self-reported anxiety, work and social adjustment, epilepsy symptoms (including seizure frequency and severity), medication adherence, potential negative treatment effects and health-related quality of life. Measurements are collected online at pre-treatment (T0), three months (T1), six months (T2), and nine months (T3). DISCUSSION Results of this trial are expected to extend the body of knowledge with regard to effective and efficient treatment options for PwE who experience elevated depression and anxiety. TRIAL REGISTRATION ClinicalTrials.gov: NCT02791724 . Registered 01 June 2016.
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Affiliation(s)
- Björn Meyer
- Research Department, Gaia Group, Gertigstr. 12-14, 22303, Hamburg, Germany. .,Department of Psychology, City, University of London, London, UK.
| | - Mario Weiss
- Research Department, Gaia Group, Gertigstr. 12-14, 22303 Hamburg, Germany ,0000 0000 9762 9163grid.467164.6Ashridge Business School, Berkhamsted, UK
| | - Martin Holtkamp
- 0000 0001 2218 4662grid.6363.0Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Stephan Arnold
- Schön Clinic Vogtareuth, Clinic for Eplilepsy, Krankenhausstraße 20, 83569 Vogtareuth, Germany
| | - Katja Brückner
- Department of Neurology and Epileptology, Epilepsy-Center Hamburg, Evangelical Hospital Alsterdorf, Elisabeth-Flügge-Straße 1, 22337 Hamburg, Germany
| | - Johanna Schröder
- 0000 0001 2180 3484grid.13648.38Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Scheibe
- Research Department, Gaia Group, Gertigstr. 12-14, 22303 Hamburg, Germany
| | - Yvonne Nestoriuc
- 0000 0001 2180 3484grid.13648.38Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Martinistraße 52, 20246 Hamburg, Germany
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Moura LMVR, Eskandar EN, Hassan M, Salinas J, Cole AJ, Hoch DB, Cash SS, Hsu J. Anterior temporal lobectomy for older adults with mesial temporal sclerosis. Epilepsy Res 2016; 127:358-365. [PMID: 27760412 DOI: 10.1016/j.eplepsyres.2016.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 09/07/2016] [Accepted: 09/29/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare postoperative seizure-free survival between older and younger adults. METHODS A retrospective cohort of 107 temporal lobe epilepsy patients with a diagnosis of mesial temporal sclerosis (MTS) received anterior temporal lobectomy (ATL) between 1993 and 2014. We divided the lower three quartiles (younger) and top quartile (older, all 47+ years) of patients, then reviewed patient registry and electronic medical records to determine time to first self-reported seizure after ATL, the primary outcome (mean=3.5years of follow-up, SD=3.6). We also assessed Engel classifications, intraoperative and postoperative treatment complications, and social disability. We used Cox proportional hazard models to assess the association between individual traits and time of seizure recurrence. RESULTS During follow-up, 35/107 (32.7%) patients had post-operative seizure(s). After adjustment for potential confounders there were no significant differences in the probability of post-operative seizures between the older and younger groups, though we had limited precision (hazard ratio of 0.67 [0.28-1.59]), (p=0.36). There were more treatment complications and disability in older patients (18% vs. 1.3% for any complications, 84.62% vs. 58.23% for driving disability, and 84.6% vs. 60.7% for work disability, p<0.05). CONCLUSION Older patients appear to have more complications after ATL, compared with younger patients. Age, however, does not appear to have a large independent association with seizure recurrence.
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Affiliation(s)
- Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
| | - Emad N Eskandar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Mursal Hassan
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Joel Salinas
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Andrew J Cole
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Daniel B Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - John Hsu
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA 02114, United States; Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States
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Moura LMVR, Carneiro TS, Thorn EL, Seitz MP, Hsu J, Cole AJ, Vickrey BG, Hoch DB. Patient perceptions of physician-documented quality care in epilepsy. Epilepsy Behav 2016; 62:90-6. [PMID: 27450312 DOI: 10.1016/j.yebeh.2016.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to compare physician encounter documentation with patient perceptions of quality of epilepsy care and examine the association between quality and patient assessment of provider communication. METHODS We identified 505 adult patients with epilepsy aged 18years or older over a 3-year period in two large academic medical centers. We abstracted individual, clinical, and care measures from 2723 electronic clinical notes written by physicians. We then randomly selected 245 patients for a phone interview. We compared patient perceptions of care with the documented care for several established epilepsy quality measures. We also explored the association of patient's perception of provider communication with provider documentation of key encounter interventions. RESULTS There were 88 patients (36%) who completed the interviews. Fifty-seven (24%) refused to participate, and 100 (40%) could not be contacted. Participants and nonparticipants were comparable in their demographic and clinical characteristics; however, participants were more often seen by epilepsy specialists than nonparticipants (75% vs. 61.9%, p<0.01). Quality scores based on patient perceptions differed from those determined by assessing the documentation in the medical record for several quality measures, e.g., documentation of side effects of antiseizure therapy (p=0.05), safety counseling (p<0.01), and counseling for women of childbearing potential with epilepsy (McNemar's p=0.03; intraclass correlation coefficient, ICC=0.07). There was a significant, positive association between patient-reported counseling during the encounter (e.g., personalized safety counseling) and patient-reported scores of provider communication (p=0.05). CONCLUSIONS The association between the patient's recollection of counseling during the visit and his/her positive perception of the provider's communication skills highlights the importance of spending time counseling patients about their epilepsy and not just determining if seizures are controlled.
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Affiliation(s)
- Lidia M V R Moura
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - Thiago S Carneiro
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - Emily L Thorn
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - Michael P Seitz
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - John Hsu
- Massachusetts General Hospital, Department of Medicine, Mongan Institute, Boston, United States; Department of Health Care Policy, Harvard Medical School, Boston, United States.
| | - Andrew J Cole
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - Barbara G Vickrey
- Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, United States.
| | - Daniel B Hoch
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
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Lee SA, Lee BI. Association of knowledge about epilepsy with mood and self-efficacy in Korean people with epilepsy. Epilepsy Behav 2015; 52:149-53. [PMID: 26414345 DOI: 10.1016/j.yebeh.2015.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE We determined the level of knowledge about epilepsy in Korean people with epilepsy (PWE) and evaluated whether this is associated with self-efficacy, perceived stigma, anxiety, and depressive mood in these patients. METHODS This was a cross-sectional multicenter study. A total of 530 PWE participated from 31 secondary or tertiary hospitals in Korea. Knowledge about epilepsy was assessed using 34 medical items (EKP-M) of the Epilepsy Knowledge Profile-General. Additional questionnaires included the Epilepsy Self-Efficacy Scale (ESES), Stigma Scale, and Hospital Anxiety and Depression Scale (HADS). Multiple linear regression analyses were used. RESULTS The mean EKP-M score was 22.2 (SD: 4.1). By univariate analyses, the EKP-M was related to ESES (r=0.220, p<0.001) and HADS-D (r=-0.154, p<0.001) scores but not to the Stigma Scale or HADS-A. By linear regression analyses, after adjusting for the confounding variables, the higher EKP-M scores were independently related to both higher ESES (p<0.001) and lower HADS-D scores (p<0.05). CONCLUSION Korean PWE have a relatively low level of knowledge about their condition. Knowledge about epilepsy is associated with a high level of self-efficacy and less depressive symptoms in affected individuals.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Byung-In Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Sajobi TT, Jette N, Zhang Y, Patten SB, Fiest KM, Engbers JDT, Lowerison MW, Wiebe S. Determinants of disease severity in adults with epilepsy: Results from the Neurological Diseases and Depression Study. Epilepsy Behav 2015; 51:170-5. [PMID: 26287469 DOI: 10.1016/j.yebeh.2015.07.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Epilepsy severity has been recognized as a significant predictor of health-related quality of life in patients with epilepsy. However, clinical markers of epilepsy severity such as seizure frequency often fail to capture important aspects of the disease. This study investigates the factors associated with patient-reported severity of epilepsy, assessed by the Global Assessment of Severity of Epilepsy (GASE) scale in adults with epilepsy. METHODS Data from a cohort of 250 patients consecutively enrolled in the Neurological Diseases and Depression Study (NEEDS) were used to assess the determinants of epilepsy severity as measured by the GASE scale. Multiple linear regression analyses were used to examine the mediation effect of clinical and sociodemographic characteristics on patients' ratings on the GASE scale. RESULTS The mean age of the study participants was 39.8 (SD=14.9) years, of which 44.4% were male. About 66.8% of the participants reported "not at all severe" or "a little severe" epilepsy, while 0.4% reported "extremely severe" epilepsy. One-year seizure freedom, number of antiseizure medications, medication side effects, depression, anxiety, and seizure-related disability were identified as significant determinants of patients' ratings of epilepsy severity. Seizure-related disability mediated the effects of 1-year seizure freedom, number of antiseizure medications, and medication side effects on epilepsy severity. CONCLUSION Overall, patients with epilepsy who reported higher GASE scores were less likely to achieve 1-year seizure freedom and more likely to be on more antiseizure medications, experience more side effects from medication, endorse more depression and anxiety symptoms, and have increased self-reported seizure-related disability. The identified determinants of global, self-rated epilepsy severity can aid the design of appropriate interventions and support services for patients with severe epilepsy.
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Affiliation(s)
- Tolulope T Sajobi
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Clinical Research Unit, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | - Nathalie Jette
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Yukun Zhang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | | | | | - Samuel Wiebe
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Clinical Research Unit, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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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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Sudden unexpected death in epilepsy (SUDEP): what do patients think? Epilepsy Behav 2015; 42:29-34. [PMID: 25499158 DOI: 10.1016/j.yebeh.2014.11.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/06/2014] [Accepted: 11/08/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in epilepsy. Despite its devastating consequences, SUDEP appears to be poorly discussed with patients by health professionals. The risk of causing psychological distress to the patient is highlighted as a reason for not discussing SUDEP. However, no studies have assessed the adult patients' views on this important question. We conducted this cross-sectional study to evaluate the awareness and perspectives on SUDEP among adult patients with epilepsy. METHODS One hundred five consecutive adult patients with epilepsy, referred to the Epilepsy Clinic of a tertiary hospital between October 2012 and November 2013, were surveyed to ascertain their views and understanding of SUDEP. The data were analyzed using logistic regression to explore the association between patients' awareness of SUDEP and characteristics such as age, gender, duration of epilepsy, level of education, and employment. RESULTS Awareness of SUDEP among adult patients with epilepsy was poor (14.3%). However, the vast majority (89.5%) wished to be informed about SUDEP, and 59% requested detailed information. The treating neurologist was considered to be the most appropriate source of SUDEP information by 85.6% of patients. Multivariable analysis of the data showed no association between characteristics of patients (age, gender, duration of epilepsy, level of education, and employment) and their awareness of SUDEP or desire to get SUDEP-related information. CONCLUSIONS Our study suggests that the majority of adult patients wish to be informed about SUDEP. This is in contrast to the general reluctance of medical professionals to inform all patients routinely about this condition.
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Hamed SA. Atherosclerosis in epilepsy: its causes and implications. Epilepsy Behav 2014; 41:290-6. [PMID: 25164495 DOI: 10.1016/j.yebeh.2014.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 07/03/2014] [Accepted: 07/04/2014] [Indexed: 12/22/2022]
Abstract
Evidence from epidemiological, longitudinal, prospective, double-blinded clinical trials as well as case reports documents age-accelerated atherosclerosis with increased carotid artery intima media thickness (CA-IMT) in patients with epilepsy. These findings raise concern regarding their implications for age-accelerated cognitive and behavioral changes in midlife and risk of later age-related cognitive disorders including neurodegenerative processes such as Alzheimer's disease (AD). Chronic epilepsy, cerebral atherosclerosis, and age-related cognitive disorders including AD share many clinical manifestations (e.g. characteristic cognitive deficits), risk factors, and structural and pathological brain abnormalities. These shared risk factors include increased CA-IMT, hyperhomocysteinemia (HHcy), lipid abnormalities, weight gain and obesity, insulin resistance (IR), and high levels of inflammatory and oxidative stresses. The resulting brain structural and pathological abnormalities include decreased volume of the hippocampus, increased cortical thinning of the frontal lobe, ventricular expansion and increased white matter ischemic disease, total brain atrophy, and β-amyloid protein deposition in the brain. The knowledge that age-accelerated atherosclerosis may contribute to age-accelerated cognitive and behavioral abnormalities and structural brain pathologies in patients with chronic epilepsy represents an important research path to pursue future clinical and management considerations.
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Affiliation(s)
- Sherifa A Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
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Chen J, Yan B, Lu H, Ren J, Zou X, Xiao F, Hong Z, Zhou D. Driving among patients with epilepsy in West China. Epilepsy Behav 2014; 33:1-6. [PMID: 24561651 DOI: 10.1016/j.yebeh.2014.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/20/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was conducted to survey the driving status of PWE in West China and to explore the sociodemographic and clinical factors associated with driving. METHODS Between October 2012 and October 2013, all adult patients who came to our epilepsy clinic in the West China Hospital were invited to participate. Logistic regression was used to detect the patient factors associated with driving. RESULTS A total of 657 patients completed this study. We found that 128 (19.5%) of these patients had driven recently (during the past year); among them, 80 (62.5%) experienced at least one seizure in the previous year. A logistic regression suggested that age, being male, being married, having a higher personal income, experiencing no seizure while awake, and taking fewer antiepileptic drugs were independently associated with recent driving. CONCLUSION This study showed that a considerable proportion of patients continue driving despite uncontrolled seizures. More detailed and operational driving restrictions may be needed for patients in China in order to strike a better balance between patients' quality of life and public safety.
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Affiliation(s)
- Jiani Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Bo Yan
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Huajun Lu
- West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Jiechuan Ren
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Xuemei Zou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Fenglai Xiao
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Zhen Hong
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China.
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Miller WR, Bakas T, Buelow JM. Problems, needs, and useful strategies in older adults self-managing epilepsy: implications for patient education and future intervention programs. Epilepsy Behav 2014; 31:25-30. [PMID: 24317297 PMCID: PMC4242009 DOI: 10.1016/j.yebeh.2013.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/10/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine, in a sample of older adults diagnosed with epilepsy, perceived self-management problems and needs encountered since diagnosis, as well as strategies used to address problems and needs. METHODS Qualitative description was used. Twenty older adults engaged in face-to-face interviews. Interviews were analyzed via content analysis. RESULTS Participants reported problems, needs, and strategies in six categories: Information, Physical and Emotional Symptoms, Memory and Concentration, Medications, Commitments, and Relationships. CONCLUSION Participants noted some problems and needs previously documented in the literature, though current results have built upon extant literature to reveal etiologies of and contexts surrounding problems and needs; new findings were also revealed. This knowledge can be used by health-care providers in counseling and educating older adults with epilepsy and can inform formal self-management interventions. PRACTICE IMPLICATIONS Determining needs from the patient's perspective is consistent with today's focus on patient-centered care. Current findings have led to an organizing framework for problems and needs of older adults with epilepsy. More research is needed to develop the framework so that it can serve as a template for an intervention. In the interim, findings can inform educational practices of those caring for this population.
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Affiliation(s)
- Wendy R Miller
- Dept. of Science in Nursing Care, Indiana University School of Nursing, Bloomington, IN, USA.
| | - Tamilyn Bakas
- Dept. of Science in Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
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Hrazdil C, Roberts JI, Wiebe S, Sauro K, Vautour M, Hanson A, Murphy W, Pillay N, Federico P, Jetté N. Patient perceptions and barriers to epilepsy surgery: evaluation in a large health region. Epilepsy Behav 2013; 28:52-65. [PMID: 23660081 DOI: 10.1016/j.yebeh.2013.03.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE Despite evidence that carefully selected patients with refractory focal epilepsy benefit from epilepsy surgery, significant delays remain. We examined patient knowledge and perceptions regarding epilepsy surgery. METHODS A 5-minute questionnaire was administered to consecutive adults with focal epilepsy seen in the epilepsy clinic in a large Canadian health region. Survey items assessed the following: (1) knowledge of surgical options, (2) perceptions about the risks of surgery vs. ongoing seizures, (3) disease disability, (4) treatment goals, and (5) demographic and socioeconomic variables. Patient responses were compiled to calculate a "Barriers to Epilepsy Surgery Composite" (BESC) score. RESULTS Of 129 eligible patients, 107 completed the questionnaire (response rate: 83%). The average BESC score was 60/100. Apprehension about epilepsy surgery was less likely among patients who had previously undergone epilepsy surgery and those born in Canada. DISCUSSION People with epilepsy often have hindering perceptions that can contribute to delays in surgical care.
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Affiliation(s)
- Chantelle Hrazdil
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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Friedman DE, Islam S, Ettinger AB. Health-related quality of life among people with epilepsy with mild seizure-related head injuries. Epilepsy Behav 2013; 27:492-6. [PMID: 23611829 DOI: 10.1016/j.yebeh.2013.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 11/25/2022]
Abstract
Seizure-related head injury (SRHI) is an under-recognized condition frequently experienced by people with epilepsy (PWE). The purpose of this study is to investigate the potential impact of SRHI on health-related quality of life (HRQOL) among PWE receiving care in a tertiary epilepsy center. Consecutive adult PWE receiving care at the Baylor Comprehensive Epilepsy Center (BCEC) were recruited for the study. After their informed consent was obtained, patients were administered the QOLIE-31 to measure HRQOL and the NDDI-E to screen for depression. Simple linear regression was used to identify clinical variables associated with HRQOL and that included SRHI obtained systematically at each clinic visit. Data were also compared between the SRHI and non-SRHI groups. Participants included 172 subjects. Recurrent mild SRHI occurred in 50 (29%) subjects. Factors with a negative effect on HRQOL included depression (slope=-19.99 [95% CI -25.16, -14.81]; p<.0001), recurrent SRHI (-17.02 [-22.35, -11.69]; p<.0001), past SRHI (-13.46 [-18.43, -8.48]; p<.0001), and seizure frequency (-0.17 [-0.26, -0.07]; p=0.001) on univariate analysis. With stepwise multiple regression, depression and recurrent SRHI significantly impacted HRQOL with slopes (95% CI; p-value) of (-17.53 [-22.34, -12.73]; p<.0001) and (-14.03 [-18.78, -9.28]; p<.0001), respectively. Patient-derived HRQOL is negatively associated with depression and recurrent SRHI, independently. There has been a justifiable increased awareness of the potential effects of head injuries among healthy individuals. Our data suggest that head injuries can certainly be detrimental among PWE, and greater efforts should be made to recognize and formulate prevention strategies for SRHI.
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Affiliation(s)
- David E Friedman
- Department of Neuroscience, Winthrop University Hospital, Mineola, NY 11501, USA.
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Bhalla D, Chea K, Chamroeun H, Vichea C, Huc P, Samleng C, Sebbag R, Gérard D, Dumas M, Oum S, Druet-Cabanac M, Preux PM. Comprehensive evaluation of the psychosocial parameters of epilepsy: A representative population-based study in Prey Veng (Cambodia). Epilepsia 2013; 54:1342-51. [DOI: 10.1111/epi.12218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Devender Bhalla
- INSERM UMR 1094; Tropical Neuroepidemiology; Limoges France
- School of Medicine; Institute of Neuroepidemiology and Tropical Neurology; CNRS FR 3503 GEIST; University of Limoges; Limoges France
- Centre Hospitalier Universitaire; Limoges France
- Cambodian Society of Neurology; Phnom Penh Cambodia
| | - Kimly Chea
- University of Health Sciences; Phnom Penh Cambodia
| | - Hun Chamroeun
- Cambodian Society of Neurology; Phnom Penh Cambodia
- University of Health Sciences; Phnom Penh Cambodia
- Department of Neurology; Calmette Hospital; Phnom Penh Cambodia
| | - Chan Vichea
- Department of Neurology; Calmette Hospital; Phnom Penh Cambodia
| | - Pierre Huc
- INSERM UMR 1094; Tropical Neuroepidemiology; Limoges France
- School of Medicine; Institute of Neuroepidemiology and Tropical Neurology; CNRS FR 3503 GEIST; University of Limoges; Limoges France
| | - Chan Samleng
- Cambodian Society of Neurology; Phnom Penh Cambodia
- University of Health Sciences; Phnom Penh Cambodia
- Department of Neurology; Calmette Hospital; Phnom Penh Cambodia
| | - Robert Sebbag
- Department of Access to Medicines; Sanofi; Gentilly France
| | - Daniel Gérard
- Department of Access to Medicines; Sanofi; Gentilly France
| | - Michel Dumas
- INSERM UMR 1094; Tropical Neuroepidemiology; Limoges France
- School of Medicine; Institute of Neuroepidemiology and Tropical Neurology; CNRS FR 3503 GEIST; University of Limoges; Limoges France
| | - Sophal Oum
- University of Health Sciences; Phnom Penh Cambodia
| | - Michel Druet-Cabanac
- INSERM UMR 1094; Tropical Neuroepidemiology; Limoges France
- School of Medicine; Institute of Neuroepidemiology and Tropical Neurology; CNRS FR 3503 GEIST; University of Limoges; Limoges France
- Centre Hospitalier Universitaire; Limoges France
| | - Pierre-Marie Preux
- INSERM UMR 1094; Tropical Neuroepidemiology; Limoges France
- School of Medicine; Institute of Neuroepidemiology and Tropical Neurology; CNRS FR 3503 GEIST; University of Limoges; Limoges France
- Centre Hospitalier Universitaire; Limoges France
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Ferreira LS, Pallhares D, Seguti VF, Gava M, Marasciulo ACE. Epilepsia e Previdência Social: a decisão médico-pericial. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2012. [DOI: 10.1590/s0303-76572012000200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A maior dificuldade encontrada no manejo de pacientes com epilepsia frente aos seguros saúde é que, apesar de todo o aparato tecnológico de que se dispõe atualmente, o diagnóstico continua sendo predominantemente clínico, não havendo critérios objetivos na definição da incapacidade laborativa. Este ensaio tem como propósito discutir necessidades e parâmetros e apresentar uma proposta de aperfeiçoamento de relatório a ser preenchido pelo médico assistente a fim de traçar estratégias para que o perito médico defina, com maior segurança, a incapacidade laborativa em segurados portadores de epilepsia. A proposta discute aspectos relacionados a diagnóstico, tratamento e prognóstico, assim como fatores que interferem na capacidade de trabalho, visando auxiliar a decisão médico-pericial acerca da concessão ou não de benefícios.
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Affiliation(s)
| | | | | | - Marília Gava
- Instituto Nacional do Seguro Social (INSS), Brasil; Instituto Nacional do Seguro Social (INSS)
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Kobau R, Luncheon C, Zack MM, Shegog R, Price PH. Satisfaction with life domains in people with epilepsy. Epilepsy Behav 2012; 25:546-51. [PMID: 23153720 PMCID: PMC5328430 DOI: 10.1016/j.yebeh.2012.09.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 09/07/2012] [Accepted: 09/08/2012] [Indexed: 11/16/2022]
Abstract
While commonly used quality-of-life instruments assess perceived epilepsy-associated limitations in life domains and formally document patient concerns, less is known of community-dwelling adults with epilepsy about their satisfaction with broader life domains, such as satisfaction with housing, education, neighborhood, ability to help others, and achievement of goals. The purpose of this study was to examine satisfaction with life domains in a representative sample of community-dwelling adults with self-reported epilepsy from the 2008 HealthStyles survey. Following adjustment for sex, age group, race/ethnicity, education, and income, people with epilepsy were more likely to report frustration in the domains of achievement (e.g., dissatisfaction with education and life goals), compromised social interactions (dissatisfaction with family life, friends, and social life), and compromised physical capability (dissatisfaction with health and energy level). Life satisfaction and other well-being domains can supplement health indicators to guide treatment and program services for people with epilepsy to maximize their well-being.
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Affiliation(s)
- Rosemarie Kobau
- Arthritis, Epilepsy and Well-Being Branch, Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341, USA.
| | - Cecily Luncheon
- Arthritis, Epilepsy and Well-Being Branch, Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341, USA
| | - Matthew M. Zack
- Arthritis, Epilepsy and Well-Being Branch, Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341, USA
| | - Ross Shegog
- Center for Health Promotion & Prevention Research, UT-School of Public Health, 7000 Fannin, Suite 2668, Houston, TX 77030, USA
| | - Patricia H. Price
- Arthritis, Epilepsy and Well-Being Branch, Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341, USA
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Epilepsy and driving: Current status of research. Epilepsy Res 2012; 102:135-52. [DOI: 10.1016/j.eplepsyres.2012.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 08/06/2012] [Accepted: 08/10/2012] [Indexed: 11/22/2022]
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Pisu M, Kratt P, Faught E, Martin RC, Kim Y, Clements K, Knowlton R, Funkhouser E, Richman JS. Geographic variation of epilepsy for older Americans: how close to the geographic variation of stroke? Epilepsia 2012; 53:2186-93. [PMID: 22958112 DOI: 10.1111/j.1528-1167.2012.03640.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Given the strong association of stroke and epilepsy in older persons, and the existence of a Stroke Belt in the United States, we hypothesized that geographic variation in epilepsy prevalence would follow geographic patterns similar to stroke. METHODS We used a 2005 5% random sample of Medicare beneficiaries 65 and older in 48 U.S. contiguous states. Epilepsy was identified from claims for physician visits, hospitalizations, and outpatient procedures. Prevalence was obtained by state and county. Logistic regressions determined the independent association of the likelihood of epilepsy (prevalent or new case) and residence in Stroke Belt states, controlling for residence in highest epilepsy prevalence states, demographics (race, age, gender), comorbid conditions, cerebrovascular disease, dementia, and county characteristics. KEY FINDINGS Of 1,212,015 beneficiaries, 11.9 per 1,000 had prevalent and 2.9 new cases of epilepsy. Nine of 11 Stroke Belt states were among the 20 states with the highest epilepsy prevalence. Counties in the 10 highest epilepsy prevalence states were more likely to be large urban counties with a higher number of neurologists or neurosurgeons per capita. The higher likelihood of prevalent epilepsy cases associated with Stroke Belt residence was explained by beneficiaries' race; that associated with residence in high epilepsy prevalence states was not. The likelihood of new epilepsy cases was negatively associated with Stroke Belt residence when controlling for covariates. SIGNIFICANCE The geographic variation in epilepsy prevalence is not explained by variations in known risk factors. Further research should investigate why eastern U.S. states have higher frequency of epilepsy.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-4410, USA.
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Disobedience and driving in patients with epilepsy. Epilepsy Behav 2012; 23:30-5. [PMID: 22112305 DOI: 10.1016/j.yebeh.2011.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/10/2011] [Accepted: 10/14/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Motor vehicle accidents direct legislators to ensure pubic safety. We attempted to characterize and quantify driving risk in patients with seizures (PWS). METHODS We delivered 12-question surveys to 287 consecutive PWS at an epilepsy clinic in Florida. Illegal and disobedient driving practices were analyzed. RESULTS Eighty-three of 236 (35.2%) PWS were eligible to drive and 62.3% were ineligible with a seizure in <6 months (P<0.001, 95% CI: 0.57-0.70). Among the ineligible responders, 23.8% (35/147) of ineligible responders were illegally driving (14.83% of cohort); 11.86% (28/236) of PWS were disobedient refusing to obey the law, and 8.9% (21/236) of PWS were defiant and knew the law. Sadness (75/236, 31.8%) was the most common reaction to restriction, but disobedient PWS were angry (10/28, 35.7%). CONCLUSION Overall, a small number of PWS are disobedient and illegally driving. A targeted approach to high-risk drivers with repeated verbal and supplemental driving information may help avoid unnecessary universal physician reporting for PWS.
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Aydemir N, Özkara Ç, Ünsal P, Canbeyli R. A comparative study of health related quality of life, psychological well-being, impact of illness and stigma in epilepsy and migraine. Seizure 2011; 20:679-85. [DOI: 10.1016/j.seizure.2011.06.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 06/23/2011] [Accepted: 06/25/2011] [Indexed: 10/17/2022] Open
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Hamiwka L, Macrodimitris S, Tellez-Zenteno JF, Metcalfe A, Wiebe S, Kwon CS, Jetté N. Social outcomes after temporal or extratemporal epilepsy surgery: A systematic review. Epilepsia 2011; 52:870-9. [DOI: 10.1111/j.1528-1167.2011.03074.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Strzelczyk A, Cenusa M, Bauer S, Hamer HM, Mothersill IW, Grunwald T, Hillenbrand B, Ebner A, Steinhoff BJ, Krämer G, Rosenow F. Management and long-term outcome in patients presenting with ictal asystole or bradycardia. Epilepsia 2011; 52:1160-7. [PMID: 21320110 DOI: 10.1111/j.1528-1167.2010.02961.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Ictal asystole (IA) and ictal bradycardia (IB) are rare autonomic symptoms during epileptic seizures and may be potentially life-threatening. Guidelines for the care of these patients are missing. The aim of this multicenter study was to evaluate the management and long-term outcome in patients with IA and IB. PATIENTS AND METHODS All patients with IA and IB were included from four epilepsy centers (Bielefeld, Kork, Marburg, and Zürich) from 2002 until 2009. Using a standardized assessment form, clinical data, treatment decisions, and outcomes were extracted from patient charts and simultaneous electroencephalography/electrocardiography (EEG/ECG) recordings. KEY FINDINGS Seizures with IA or IB were identified in 16 patients. In all patients an associated temporal seizure pattern was recorded and in 15 patients, sudden falls, fainting, or trauma was previously reported or recorded during the monitoring. In three patients (18.8%) diagnosis of focal epilepsy was newly established and anticonvulsive treatment was initiated. Two patients with refractory epilepsy underwent epilepsy surgery. In seven patients (43.8%) a cardiac pacemaker was implanted. In 14 of 16 treated patients, seizure freedom (n = 5) or absence of sudden falls, fainting, or trauma (n = 9) could be achieved. Two patients denied epilepsy surgery as well as a pacemaker and continue to have frequent falls and trauma. SIGNIFICANCE Our study demonstrates that epilepsy surgery and antiepileptic drugs may lead to sustained freedom of seizures as well as ictal syncope. In drug-resistant patients not suitable for epilepsy surgery, implantation of a cardiac pacemaker may prevent sudden falls as well as trauma. Based on our results and previously reported cases we propose a treatment algorithm.
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Affiliation(s)
- Adam Strzelczyk
- Department of Neurology and Epilepsy Center, Marburg, Germany Swiss Epilepsy Centre, Zürich, Switzerland.
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McAuley JW, Elliott JO, Patankar S, Hart S, Long L, Moore JL, Shneker BF. Comparing patients' and practitioners' views on epilepsy concerns: a call to address memory concerns. Epilepsy Behav 2010; 19:580-3. [PMID: 20889386 DOI: 10.1016/j.yebeh.2010.09.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 08/30/2010] [Accepted: 09/03/2010] [Indexed: 10/19/2022]
Abstract
The objective was to compare practitioners' impressions of patients' concerns with those expressed by the patients themselves. Prior to clinical interaction, adult patients with epilepsy and their established practitioners were asked to choose their top five concerns via a modified version of the Epilepsy Foundation Concerns Index. Patients with epilepsy (n=257) with varying degrees of seizure control from the outpatient clinic practices of five prescribing practitioners completed the modified concerns index. The three most frequent concerns reported by patients were having a seizure unexpectedly, issues related to driving, and memory problems. These were similar to those reported by the practitioners, though memory was much less of a concern expressed by the practitioner. For the paired data, the concern with the largest gap from the patients' perspective was "your memory." Though there was an overlap, patients were concerned more about life issues and practitioners were concerned about clinical issues. This should serve as a major "wakeup call" to address memory problems in patients with epilepsy, regardless of seizure control.
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Affiliation(s)
- James W McAuley
- College of Pharmacy, Ohio State University, Columbus, OH 43210, USA.
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Choi EJ, Lee SA, Jo KD, Yim SB, No YJ, Kwon JH, Lee EM. Factors contributing to concerns of persons living with epilepsy. Seizure 2010; 20:14-7. [PMID: 20934354 DOI: 10.1016/j.seizure.2010.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 09/01/2010] [Accepted: 09/10/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To describe the concerns of Korean adults living with epilepsy and to compare the concerns of individuals with controlled and uncontrolled seizures. METHODS Outpatients filled out questionnaires, including the Hospital Anxiety and Depression Scale, the Quality of Life in Epilepsy-10 questionnaire, the stigma scale, and a questionnaire on episodes of discrimination. Patients were asked to fill out the Epilepsy Foundation of America (EFA) Concerns Index and to list their concerns on a blank sheet of paper. RESULTS Of the 178 participants, 152 described a total of 470 concerns, which could be assorted into 25 distinct concerns. Worrying about the hereditability of their condition was the only concern that differed significantly between individuals with controlled and uncontrolled seizures. Three significant factors were identified on the total EFA Concerns Index score: level of anxiety/depression (34.4%), age (6.3%), and degree of social discrimination (4.3%), resulting in a total explained variance of 45.0%. CONCLUSIONS Korean adults with epilepsy had various concerns, with some differing from those in Western populations. Anxiety/depression, age and degree of discrimination were significantly associated with the degree of concern in Korean patients with epilepsy.
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Affiliation(s)
- Eun-Ju Choi
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Effects of oxcarbazepine and carbamazepine on driving ability: a double-blind, randomized crossover trial with healthy volunteers. Psychopharmacology (Berl) 2010; 210:53-63. [PMID: 20237772 DOI: 10.1007/s00213-010-1814-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 02/22/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE Carbamazepine (CBZ) is known to produce cognitive side effects being at least partly relevant for driving. In contrast to this, the cognitive effects of oxcarbazepine (OXC) are suspected to be less pronounced. OBJECTIVE This study aimed to test 900 mg/day OXC as compared to 600 mg/day CBZ with respect to driving. METHODS Driving performance of 27 healthy volunteers under subchronic treatment of OXC and CBZ was assessed in a driving simulator with a double-blind, randomized, crossover design including a baseline measurement. The test course contained a representative set of scenarios. Lane-keeping performance, driving mistakes, and eyelid closure (as a behavioral measure of sleepiness) were analyzed. In addition, subjects were asked to assess their driving performance, effort, attention, and sleepiness subjectively. RESULTS Both drugs had negative effects on driving as reflected in poorer lane-keeping performance, higher rate of driving mistakes, increased sleepiness, and worse subjective ratings. These effects were most obvious in monotonous situations and could be compensated in situations challenging to cognitive and motor driving skills. With respect to all considered parameters, CBZ did more often differ significantly from baseline than OXC. CONCLUSIONS Under both drugs, driving performance was worse than at baseline. Even though deterioration of driving performance was only slightly less pronounced under OXC than under CBZ, it might be recommended as more appropriate than CBZ for epileptic patients who need to drive a car.
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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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Friedman DE, Gilliam FG. Seizure-related injuries are underreported in pharmacoresistant localization-related epilepsy. Epilepsia 2010; 51:43-7. [DOI: 10.1111/j.1528-1167.2009.02170.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jacoby A, Snape D, Baker GA. Determinants of Quality of Life in People with Epilepsy. Neurol Clin 2009; 27:843-863. [DOI: 10.1016/j.ncl.2009.06.003] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aydemir N, Trung DV, Snape D, Baker GA, Jacoby A. Multiple impacts of epilepsy and contributing factors: findings from an ethnographic study in Vietnam. Epilepsy Behav 2009; 16:512-20. [PMID: 19800851 PMCID: PMC2811872 DOI: 10.1016/j.yebeh.2009.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/04/2009] [Accepted: 09/06/2009] [Indexed: 11/19/2022]
Abstract
We investigated issues related to treatment, impact of epilepsy, attitudes toward epilepsy, and disclosure in Vietnam through in-depth interviews with people with epilepsy (PWE) and their family members. We found that although participants prefer Western to traditional treatment, they experience problems in accessing different kinds of antiepileptic drugs and higher-level treatment facilities and with respect to treatment expenses. The impact of epilepsy can be observed in a wide range of daily living activities which include working, education, marriage, and family formation. Although both families and society at large do not hold negative attitudes toward epilepsy, most PWE reported a sense of burden to others. Both PWE and family members generally prefer disclosing epilepsy rather than concealing it from others. Our findings strongly suggest a need in Vietnam for different types of antiepileptic drugs and epilepsy support information for PWE, family members, and the general public.
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Affiliation(s)
- Nuran Aydemir
- Department of Psychology, Izmir University of Economics, Turkey
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Konda K, Ablah E, Konda KS, Liow K. Health behaviors and conditions of persons with epilepsy: a bivariate analysis of 2006 BRFSS data. Epilepsy Behav 2009; 16:120-7. [PMID: 19682953 DOI: 10.1016/j.yebeh.2009.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 06/17/2009] [Accepted: 07/05/2009] [Indexed: 11/28/2022]
Abstract
Using amalgamated Behavioral Risk Factor Surveillance System (BRFSS) data from nine states in 2006, this study examined the differences in demographics, health conditions, health behaviors, and quality of life among persons with active epilepsy (PWAE) and persons with a lifetime prevalence of epilepsy (PWLE), compared with persons without epilepsy (PWOE). Frequencies for PWAE, PWLE, and PWOE by selected health behaviors, health conditions, quality of life, and demographic variables were produced. Differences between persons with and without epilepsy were analyzed. Results indicated smoking and unemployment rates were significantly higher among PWLE/PWAE than among PWOE. PWLE/PWAE were also less likely than PWOE to report advanced educational attainment, and more likely to report suffering physical, mental, or emotional limitations that affected their activities in some way. Hispanics were less likely to report a lifetime or active prevalence of epilepsy than people without epilepsy. PWLE/PWAE report several differences in demographics, health conditions, health behaviors, and quality of life compared to people without epilepsy.
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Affiliation(s)
- Kurt Konda
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, KS 67214-3199, USA
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