1
|
Zoulou O, Maiouak M, El Fakir S, Tachfouti N, Souirti Z. Quality of life predictors among Moroccan adults with epilepsy. Clin Neurol Neurosurg 2024; 241:108282. [PMID: 38669787 DOI: 10.1016/j.clineuro.2024.108282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE This study aimed to determine the factors associated with quality of life (QOL) in adult patients living with epilepsy in Morocco. METHODS 110 patients with epilepsy aging 18 years old were interviewed using the standard and validated Moroccan version of the Quality of Life in Epilepsy inventory with 31 items (QOLIE-31). Descriptive statistics, one-way ANOVA, and multivariate regression were used for data analysis. RESULTS The mean age of the patients was 35.70 years old (standard deviation (SD)12.2). The mean total score of QOLIE-31 was 43.6±10.2. The highest mean±SD score was the medication effects subscale 52.3±12.1, and the lowest was the overall quality of life subscale 39.2±13.2. Patients with no seizure episode during the last month had a better mean total score of QOLIE-31 (47.6±10.5) than the study participants having a seizure in the last month (40.6±8.9, p≤0.001). These data supported that presence of seizure in the past 4 weeks (β=4.626, CI95 % 1.123; 8.130), memory disorders (β=10.025, IC 95 % 2.811; 17.239), seizure trigger factors such as forgetting to take antiepileptic drugs (AEDs) (β=5.205, IC 95 % 1.769; 8.641), personal problems (β=4.957, IC 95 % 0.604; 9.310), low monthly income (<2000MAD, 194.94$: β= -9.937, IC 95 % -18.536; -1.338), (2000-5000MAD, 194.94$- 487.35$: β= -24.804, IC 95 % -43.171; -6.437), and employment (β= -4.291, IC 95 % -7.976; -0.605) were the factors associated with QOL. SIGNIFICANCE The overall QOL of patients with epilepsy was low. This study showed that the presence of seizures, memory disorders, monthly income, trigger factors, and employment status were QOL predictors for epileptic patients.
Collapse
Affiliation(s)
- Oumaima Zoulou
- Clinical Neurosciences Laboratory, Faculty of Medicine, Pharmacy and Dentistry of Fez, Morocco, Sidi Mohammed Ben Abdellah University, Morocco
| | - Moncef Maiouak
- Epidemiology and Clinical Research Laboratory, Faculty of Medicine, Pharmacy and Dentistry of Fez, Morocco, Sidi Mohammed Ben Abdellah University, Morocco
| | - Samira El Fakir
- Epidemiology and Clinical Research Laboratory, Faculty of Medicine, Pharmacy and Dentistry of Fez, Morocco, Sidi Mohammed Ben Abdellah University, Morocco
| | - Nabil Tachfouti
- Epidemiology and Clinical Research Laboratory, Faculty of Medicine, Pharmacy and Dentistry of Fez, Morocco, Sidi Mohammed Ben Abdellah University, Morocco
| | - Zouhayr Souirti
- Clinical Neurosciences Laboratory, Faculty of Medicine, Pharmacy and Dentistry of Fez, Morocco, Sidi Mohammed Ben Abdellah University, Morocco; Neurology Department, Hassan II University Hospital of Fez, Morocco, Sidi Mohammed Ben Abdellah University, Morocco.
| |
Collapse
|
2
|
McLaren JR, Kahle KT, Richardson RM, Chu CJ. Epilepsy Surgery for Cognitive Improvement in Epileptic Encephalopathy. Neurosurg Clin N Am 2024; 35:49-59. [PMID: 38000841 DOI: 10.1016/j.nec.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Epileptic encephalopathies are defined by the presence of frequent epileptiform activity that causes neurodevelopmental slowing or regression. Here, we review evidence that epilepsy surgery improves neurodevelopment in children with epileptic encephalopathies. We describe an example patient with epileptic encephalopathy without drug refractory seizures, who underwent successful diagnostic and therapeutic surgeries. In patients with epileptic encephalopathy, cognitive improvement alone is a sufficient indication to recommend surgical intervention in experienced centers.
Collapse
Affiliation(s)
- John R McLaren
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School
| | - Kristopher T Kahle
- Harvard Medical School; Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Wang Building Room 333, Boston, MA 02114, USA
| | - R Mark Richardson
- Harvard Medical School; Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Their Building, 4th Floor, Boston, MA 02114, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School.
| |
Collapse
|
3
|
Aiello EN, D’Iorio A, Montemurro S, Maggi G, Giacobbe C, Bari V, Di Tella GS, Pischedda F, Bolognini N, Appollonio I, Arcara G, Santangelo G. Psychometrics, diagnostics and usability of Italian tools assessing behavioural and functional outcomes in neurological, geriatric and psychiatric disorders: a systematic review. Neurol Sci 2022; 43:6189-6214. [PMID: 35932375 PMCID: PMC9616758 DOI: 10.1007/s10072-022-06300-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Abstract
Background Psychometric instruments assessing behavioural and functional outcomes (BFIs) in neurological, geriatric and psychiatric populations are relevant towards diagnostics, prognosis and intervention. However, BFIs often happen not to meet methodological-statistical standards, thus lowering their level of recommendation in clinical practice and research. This work thus aimed at (1) providing an up-to-date compendium on psychometrics, diagnostics and usability of available Italian BFIs and (2) delivering evidence-based information on their level of recommendation. Methods This review was pre-registered (PROSPERO ID: CRD42021295430) and performed according to PRISMA guidelines. Several psychometric, diagnostic and usability measures were addressed as outcomes. Quality assessment was performed via an ad hoc checklist, the Behavioural and Functional Instrument Quality Assessment. Results Out of an initial N = 830 reports, 108 studies were included (N = 102 BFIs). Target constructs included behavioural/psychiatric symptoms, quality of life and physical functioning. BFIs were either self- or caregiver-/clinician-report. Studies in clinical conditions (including neurological, psychiatric and geriatric ones) were the most represented. Validity was investigated for 85 and reliability for 80 BFIs, respectively. Criterion and factorial validity testing were infrequent, whereas content and ecological validity and parallel forms were almost never addressed. Item response theory analyses were seldom carried out. Diagnostics and norms lacked for about one-third of BFIs. Information on administration time, ease of use and ceiling/floor effects were often unreported. Discussion Several available BFIs for the Italian population do not meet adequate statistical-methodological standards, this prompting a greater care from researchers involved in their development. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06300-8.
Collapse
|
4
|
Rauh R, Schulze-Bonhage A, Metternich B. Assessment of Anxiety in Patients With Epilepsy: A Literature Review. Front Neurol 2022; 13:836321. [PMID: 35547374 PMCID: PMC9081800 DOI: 10.3389/fneur.2022.836321] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/16/2022] [Indexed: 01/07/2023] Open
Abstract
Objective Approximately 20% of people with epilepsy (PWE) suffer from anxiety. These fears are quite diverse and may manifest periictally or interictally, be part of the seizure's semiology, or an expression of reactive psychological distress from seizures themselves. Our review addresses the question of what screening tools are used in clinical care and epileptological research to capture the complexity of epilepsy-specific anxieties. Method On 2021/11/11, we entered a search string in PubMed that covered our research interest as completely as possible. We also screened the bibliographies of our findings and followed PubMed's recommendations. From the assessments we found in the included studies, we extracted domains that represent the range of manifestations of anxiety, in order to compare the tools and to discuss to what extent they are suitable for assessing epilepsy-specific anxieties. Results We screened 1,621 abstracts. In total, we identified 24 different anxiety assessments. In addition to the psychiatric assessments in use, we found 7 tools that were designed to assess epilepsy-specific anxieties. The latter focus on different aspects of epilepsy-specific anxieties. In some cases, the conceptual frameworks are not sufficiently transparent or divergent. Conclusion Because a diagnosis of epilepsy can result in, or seizures may appear as, anxiety, it is important to better understand this psychological burden and address it therapeutically, if necessary. There is a need for screening tools that integrate specific points of a variety of assessments, so as to cover the broad range of epilepsy-specific fears. None of the assessments we found meets this integrative perspective. At the same time, the appropriate design of such a required tool presupposes a conceptual framework of what should be considered as epilepsy-specific anxiety.
Collapse
Affiliation(s)
- Raphael Rauh
- Epilepsy Center, University Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Birgitta Metternich
- Epilepsy Center, University Medical Center, University of Freiburg, Freiburg, Germany
| |
Collapse
|
5
|
Lozano-García A, Hampel KG, Villanueva V, González-Bono E, Cano-López I. The number of anti-seizure medications mediates the relationship between cognitive performance and quality of life in temporal lobe epilepsy. Epilepsy Behav 2021; 115:107699. [PMID: 33412368 DOI: 10.1016/j.yebeh.2020.107699] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess whether cognitive performance predicts quality of life (QOL) in patients with drug-resistant temporal lobe epilepsy (TLE), using the Epitrack cognitive screening tool, while considering the mediating role of the number of anti-seizure medications (ASMs) and controlling for seizure-related, social, and emotional factors. METHODS Seventy-five adult patients with drug-resistant TLE (mean age = 39.76 years, SD = 11.66) underwent a presurgical neuropsychological assessment. MAIN OUTCOME MEASURES Cognitive performance (Epitrack), depression (BDI-II), trait anxiety (STAI); and QOL (QOLIE-31) were assessed. RESULTS Adjusting for seizure-related, social, and emotional factors, the Epitrack total score significantly contributed to QOL composite score, and energy and cognitive self-rating subscales. We found a significant indirect effect of the Epitrack total score on QOL composite score and seizure worry and social functioning subscales via the number of ASMs. CONCLUSION Our findings underline the relevance of cognitive functioning on QOL and the clinical utility of Epitrack to track cognitive side effects of ASMs and, consequently, to predict and manage QOL in this population.
Collapse
Affiliation(s)
- Alejandro Lozano-García
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026 Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026 Valencia, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Irene Cano-López
- Valencian International University, C/Pintor Sorolla, 21, 46002 Valencia, Spain.
| |
Collapse
|
6
|
Citherlet D, Boucher O, Gravel V, Roy-Côté F, Bouthillier A, Nguyen DK. The effects of insular and mesiotemporal lesions on affective information processing: Preliminary evidence from patients with epilepsy surgery. Epilepsy Behav 2020; 111:107264. [PMID: 32640413 DOI: 10.1016/j.yebeh.2020.107264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022]
Abstract
Depressive symptoms and anxiety are common complaints in patients who have had epilepsy surgery. Recent studies have reported disturbances in emotional memory, facial and vocal emotion recognition, and affective learning after temporal lobe and/or insular resection for drug-resistant seizures, suggesting that these regions may be involved in emotional processes underlying psychological symptoms. The insula is a core component of the salience network and is thought to be involved in processing emotions such as disgust, and the role of mesial temporal lobe structures in affective processing is well established. However, to our knowledge, no study has yet investigated whether attentional processing of affective information is altered when these structures are resected as part of an epilepsy surgery. The present study examined the interference control capacity and attentional biases for emotional information in adult patients with epilepsy who underwent temporal lobe resections including the amygdala and hippocampus (n = 15) and/or partial or complete insular resections (n = 16). Patients were tested on an Emotional Stroop test and on a Dot-Probe task using fearful and disgusting pictures and were compared with a healthy control group (n = 30) matched for age, gender, and education. Repeated-measures analyses of variances revealed a significant effect of emotional words on color naming speed in the Emotional Stroop task among insular patients, which was not observed in the other groups. By contrast, the groups did not differ on Dot-Probe task performance. These preliminary findings suggest that insular damage may alter emotional interference control.
Collapse
Affiliation(s)
- Daphné Citherlet
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de neurosciences, Montreal, Canada
| | - Olivier Boucher
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de psychologie, Montreal, Canada; CHUM, Service de psychologie, Montreal, Quebec, Canada
| | - Victoria Gravel
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de psychologie, Montreal, Canada
| | - Frédérique Roy-Côté
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de psychologie, Montreal, Canada
| | | | - Dang Khoa Nguyen
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Université de Montréal, Département de neurosciences, Montreal, Canada; CHUM, Service de neurologie, Montreal, Quebec, Canada.
| |
Collapse
|
7
|
Bartolini E, Sander JW. Dealing with the storm: An overview of seizure precipitants and spontaneous seizure worsening in drug-resistant epilepsy. Epilepsy Behav 2019; 97:212-218. [PMID: 31254841 DOI: 10.1016/j.yebeh.2019.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
In drug-resistant epilepsy, periods of seizure stability may alternate with abrupt worsening, with frequent seizures limiting the individual's independence and physical, social, and psychological well-being. Here, we review the literature focusing on different clinical scenarios related to seizure aggravation in people with drug-resistant epilepsy. The role of antiseizure medication (ASM) changes is examined, especially focusing on paradoxical seizure aggravation after increased treatment. The external provocative factors that unbalance the brittle equilibrium of seizure control are reviewed, distinguishing between unspecific triggering factors, specific precipitants, and 'reflex' mechanisms. The chance of intervening surgical or medical conditions, including somatic comorbidities and epilepsy surgery failure, causing increased seizures is discussed. Spontaneous exacerbation is also explored, emphasizing recent findings on subject-specific circadian and ultradian rhythms. Awareness of external precipitants and understanding the subject-specific spontaneous epilepsy course may allow individuals to modify their lifestyles. It also allows clinicians to counsel appropriately and to institute suitable medical treatment to avoid sudden loss of seizure control.
Collapse
Affiliation(s)
- Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, via suor Niccolina Infermiera 20, 59100 Prato, Italy.
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Achterweg 5, Heemstede 2103 SW, the Netherlands.
| |
Collapse
|
8
|
Tao L, Zhang X, Duan Z, Wang Y, Liu J, Hou H, Fang Q. Sexual dysfunction and associated factors in Chinese Han women with epilepsy. Epilepsy Behav 2018; 85:150-156. [PMID: 29940378 DOI: 10.1016/j.yebeh.2018.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/28/2018] [Accepted: 06/01/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Women with epilepsy (WWE) are believed to be at risk of sexual dysfunction (SD) and face many sexual challenges because of multiple factors. This study aimed to assess the factors associated with SD in Chinese Han WWE. METHODS This cross-sectional study examined 112 married WWE in the Affiliated Hospital of Yangzhou University with focal (FE) or generalized epilepsy (GE) on antiepileptic drugs (AEDs), and 120 healthy controls without epilepsy, all of Chinese Han nationality. Data collection tools included the Chinese version of Female Sexual Function Index (FSFI), the Chinese version of Zung Self-Rating Anxiety Scale (SAS), the Chinese version of the Zung Self-Rating Depression Scale (SDS), the Chinese version of the revised Morisky Medication Adherence Scale (MMAS-8), and the Chinese version of the National Hospital Seizure Severity Scale (NHS3). Chi-square test, t-test, one-way analysis of variance (ANOVA), and binary logistic regression were used for statistical analysis. RESULTS A high rate (70.5%) of SD was detected in WWE, with 24.2% in controls. Sexual dysfunction affected all dimensions: desire (85.7%), arousal (56.3%), lubrication (47.3%), orgasm (66.1%), satisfaction (58.9%), and pain (41.1%). Elevated rates of anxiety (40.2%) and depression (33%) and poor medication adherence (31.3%) were also found in WWE. Binary logistic regression found that poor economic status (odds ratio (OR) = 13.904, 95% confidence interval (CI): 2.025-95.472, P = 0.007 and OR = 6.350, 95% CI: 1.323-30.477, P = 0.021), anxiety (OR = 1.222, 95% CI: 1.055-1.415, P = 0.007), and poor medication adherence (OR = 0.297, 95% CI: 0.124-0.707, P = 0.006) were associated with SD. CONCLUSIONS The associated factors of SD in Chinese Han WWE are multifactorial. The WWE have higher levels of anxiety, poor family economic status, and poor medication adherence. Medical professionals should not only better control seizures but also evaluate and improve patients' sexual function so as to improve the quality of life of WWE.
Collapse
Affiliation(s)
- Lihong Tao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China; Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Xinjiang Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Zuowei Duan
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Yingge Wang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Jiangbing Liu
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Hongling Hou
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
| |
Collapse
|
9
|
Bjørke AB, Nome CG, Falk RS, Gjerstad L, Taubøll E, Heuser K. Evaluation of long-term antiepileptic drug use in patients with temporal lobe epilepsy: Assessment of risk factors for drug resistance and polypharmacy. Seizure 2018; 61:63-70. [PMID: 30099235 DOI: 10.1016/j.seizure.2018.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/12/2018] [Accepted: 07/14/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate risk factors for drug resistance and polypharmacy in patients with temporal lobe epilepsy. METHODS Patients with temporal lobe epilepsy, treated for more than 5 years, completed questionnaires on antiepileptic drug use and effect. Logistic regression models were used for analysis of risk factors. RESULTS Of 135 patients included in the study, 65% were classified as drug resistant and 41% identified as using polypharmacy. Poor effects associated with first-choice antiepileptic drug were reported by 59% of the patients, and 70% reported poor effects of second-line treatment. The most frequently used first-generation antiepileptic drugs had a similar mean effect to those of second-generation. Univariate regression analyses showed a significant association between drug resistance and mesial temporal sclerosis, seizure onset below 18 years, and lack of family history of epilepsy. However, multivariate regression analysis showed no association with any demographic or clinical features. Unsuccessful treatment with the first antiepileptic drug increased the risk of drug resistance by 18 times, and the risk of poor effect from the second antiepileptic drug by 9 times. Disease duration was associated with annual risk for drug resistance of 7% and for polypharmacy of 5%. CONCLUSIONS A poor effect from initial pharmacotherapy is the only early risk factor for drug resistance found in this study. Long disease duration increases the risk of drug resistance and polypharmacy. Second-generation antiepileptic drugs provide no additional effect for poor responders to first-generation drugs.
Collapse
Affiliation(s)
- Agnes Balint Bjørke
- Department of Neurology, Division of Clinical Neuroscience, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Neurology, Division of Neurology, Rheumatology and Habilitation, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
| | - Cecilie Gjessing Nome
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
| | - Leif Gjerstad
- Department of Neurology, Division of Clinical Neuroscience, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Erik Taubøll
- Department of Neurology, Division of Clinical Neuroscience, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Kjell Heuser
- Department of Neurology, Division of Clinical Neuroscience, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
| |
Collapse
|
10
|
Joshi R, Tripathi M, Gupta P, Gulati S, Gupta YK. Adverse effects & drug load of antiepileptic drugs in patients with epilepsy: Monotherapy versus polytherapy. Indian J Med Res 2018; 145:317-326. [PMID: 28749393 PMCID: PMC5555059 DOI: 10.4103/ijmr.ijmr_710_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background & objectives: Although the need for a combination of antiepileptic drugs (AEDs) in the treatment of epilepsy is well justified, but an associated increase in adverse effects (AEs) lends a restriction to polytherapy. The aim of this study was to evaluate AEs and drug load (prescribed daily dose/defined daily doses) of AEDs in patients with epilepsy (PWE). Methods: Consecutive PWEs attending Epilepsy clinic in a tertiary care hospital in New Delhi, India, were enrolled in the study. Demographic variables, such as age, gender, diagnosis, age at onset of seizures, frequency of seizures, use of all AEDs and adverse event profile (AEP) score were noted. Routine laboratory tests including lipid profile, fasting blood glucose, haematological parameters and liver and kidney function tests were done. Results: A total of 697 consecutive patients were included in this study. Of them, 64.4 per cent were male; mean age was 29.6 ± 10.6 yr. Generalized seizures and focal seizures were recorded in n=386 (55.4%) and n=311 (44.6%), respectively. Monotherapy and polytherapy with two and greater than or equal to three AEDs were prescribed in 264 (37.9%), 243 (34.9%) and 190 (27.2%) patients, respectively. The average AED load, duration of treatment as well as AEP score were found to be significantly higher in combination of greater than or equal to three AEDs as compared to both monotherapy and combination of two AEDs, whereas no significant difference was observed between monotherapy and combination of two AEDs. Patients on monotherapy were in good control of seizures as compared to polytherapy. There was no significant change in biochemical parameters between the groups. Interpretation & conclusions: Polytherapy with combination of greater than or equal to three AEDs was associated with higher AEs and lower seizure control as compared to both monotherapy and combination of two AEDs. AEs did not correlate with AED load, seizure type, gender and age of the patients but were associated with both numbers of AEDs as well as seizure frequency in PWE.
Collapse
Affiliation(s)
- Rupa Joshi
- Department of Pharmacology, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Gupta
- Department of Pharmacology, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department of Paediatrics, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
11
|
Atarodi-Kashani Z, Kariman N, Ebadi A, Alavi Majd H, Beladi-Moghadam N. Sexual function and related factors in Iranian woman with epilepsy. Seizure 2017; 52:147-153. [DOI: 10.1016/j.seizure.2017.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/30/2017] [Accepted: 10/02/2017] [Indexed: 11/08/2022] Open
|
12
|
Puligheddu M, Melis M, Pillolla G, Milioli G, Parrino L, Terzano GM, Aroni S, Sagheddu C, Marrosu F, Pistis M, Muntoni AL. Rationale for an adjunctive therapy with fenofibrate in pharmacoresistant nocturnal frontal lobe epilepsy. Epilepsia 2017; 58:1762-1770. [DOI: 10.1111/epi.13863] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Monica Puligheddu
- Sleep Disorder Research Center; Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - Miriam Melis
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
| | - Giuliano Pillolla
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
| | - Giulia Milioli
- Department of Neurosciences; Sleep Disorder Center; University of Parma; Parma Italy
| | - Liborio Parrino
- Department of Neurosciences; Sleep Disorder Center; University of Parma; Parma Italy
| | | | - Sonia Aroni
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
| | - Claudia Sagheddu
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
| | - Francesco Marrosu
- Sleep Disorder Research Center; Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - Marco Pistis
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
- Neuroscience Institute; National Research Council of Italy; Cagliari Italy
| | - Anna Lisa Muntoni
- Neuroscience Institute; National Research Council of Italy; Cagliari Italy
| |
Collapse
|
13
|
Mula M. The pharmacological management of psychiatric comorbidities in patients with epilepsy. Pharmacol Res 2016; 107:147-153. [PMID: 27001226 DOI: 10.1016/j.phrs.2016.03.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 01/04/2023]
Abstract
Psychiatric disorders represent a frequent comorbidity in patients with epilepsy affecting quality of life, morbidity and mortality. Evidence-based data on the management of these conditions are limited but a number of recommendations are now available to guide clinical practice. The present paper reviews the pharmacological treatment of psychiatric problems in epilepsy with special attention to data coming from randomised controlled trials (RCTs), pharmacological interactions with AEDs and the issue of seizure worsening during treatment with psychotropic drugs. Epidemiologically or clinically relevant psychiatric conditions are discussed namely mood and anxiety disorders, psychoses and attention deficit hyperactivity disorder.
Collapse
Affiliation(s)
- Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St. Georges University Hospitals NHS Foundation Trust, London, United Kingdom; South West London & St. Georges Mental Health Trust, London, United Kingdom; Institute of Medical and Biomedical Sciences, St. Georges University of London, United Kingdom.
| |
Collapse
|
14
|
Karlov VA, Guekht AB, Guzeva VI, Lipatova LV, Bazilevich SN, Mkrtchyan VR, Vlasov PN, Zhidkova IA, Mukhin KY, Petrukhin AS, Lebedeva AV. [Algorithms of mono- and polytherapy in clinical epileptology]. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [PMID: 28635941 DOI: 10.17116/jnevro201611671120-129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The large number of antiepileptic drugs (AEDs) at the physician's disposal provides not only a broad therapeutic potential in the treatment of epilepsy (EP), but creates difficulties in the adequate choice of AED. The sufficient experience in the management of patients with epilepsy has been gained so far in the world, based on which the International League Against Epilepsy (ILAE), updated classification, adopted the basic definition of efficiency, remission, resistance, evidence of research on the effectiveness of AED therapy, and introduced the concept of "resolved" epilepsy. In this article, a group of Russian experts suggest recommendations on the main steps in the choice of therapy in epilepsy. Possible drug interactions between different AEDs and other drugs as well as main characteristics of mono- and polytherapy of epilepsy are described. Some features of the use of AEDs in the elderly, characteristics of the "female" epilepsy related to the reproductive function and basic requirements for the therapy of epilepsy in children are presented.
Collapse
Affiliation(s)
- V A Karlov
- Evdokimov Moscow State Medical and Dentistry University, Moscow, Russia
| | - A B Guekht
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V I Guzeva
- Saint-Petersburg State Medical Academy, St. Petersburg, Russia
| | - L V Lipatova
- Bekhterev Saint-Petersburg Research Psychoneurological Institute, St. Petersburg, Russia
| | | | - V R Mkrtchyan
- Soloviev Scientific-Practical Psycho-Neurological Сenter, Moscow, Russia
| | - P N Vlasov
- Evdokimov Moscow State Medical and Dentistry University, Moscow, Russia
| | - I A Zhidkova
- Evdokimov Moscow State Medical and Dentistry University, Moscow, Russia
| | - K Yu Mukhin
- Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow, Russia
| | - A S Petrukhin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Lebedeva
- Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
15
|
Quality of life is social – Towards an improvement of social abilities in patients with epilepsy. Seizure 2015; 26:12-21. [DOI: 10.1016/j.seizure.2014.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/30/2014] [Accepted: 12/16/2014] [Indexed: 12/20/2022] Open
|
16
|
Jacoby A, Baker GA, Crossley J, Schachter S. Tools for assessing quality of life in epilepsy patients. Expert Rev Neurother 2013; 13:1355-69. [PMID: 24215282 DOI: 10.1586/14737175.2013.850032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this review, we attempt to bring the reader up to date with recent developments in the area of assessment of quality of life (QOL) of patients with epilepsy, in both the research and clinical contexts. We present evidence from recent publications on the major and most commonly used QOL instruments for both adults and children with epilepsy, including both strengths and limitations. We discuss both generic measures and ones that have been developed specifically for use in the epilepsy population. We draw attention to some of the broader issues that render the QOL assessment endeavor a somewhat complex one - in particular, that epilepsy is not a single condition, with a common clinical trajectory; and that QOL measures as currently configured almost universally focus on its negative impacts, largely neglecting the possibility of those affected being able to retain reasonable social adjustment and life satisfaction. Finally, we suggest that further work needs to focus on plugging the current evidence gaps in relation to psychometric and cross-cultural applicability issues; and on the value of QOL instruments in the clinical care setting. We conclude by highlighting a number of issues from the QOL literature that will, in our view, be the focus of increasing research interest in the next few years.
Collapse
Affiliation(s)
- Ann Jacoby
- Department of Public Health & Policy, University of Liverpool, Liverpool, L69 3GB, UK
| | | | | | | |
Collapse
|
17
|
Nixon A, Kerr C, Breheny K, Wild D. Patient Reported Outcome (PRO) assessment in epilepsy: a review of epilepsy-specific PROs according to the Food and Drug Administration (FDA) regulatory requirements. Health Qual Life Outcomes 2013; 11:38. [PMID: 23497117 PMCID: PMC3606363 DOI: 10.1186/1477-7525-11-38] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
Despite collection of patient reported outcome (PRO) data in clinical trials of antiepileptic drugs (AEDs), PRO results are not being routinely reported on European Medicines Agency (EMA) and Food and Drug Administration (FDA) product labels. This review aimed to evaluate epilepsy-specific PRO instruments against FDA regulatory standards for supporting label claims. Structured literature searches were conducted in Embase and Medline databases to identify epilepsy-specific PRO instruments. Only instruments that could potentially be impacted by pharmacological treatment, were completed by adults and had evidence of some validation work were selected for review. A total of 26 PROs were reviewed based on criteria developed from the FDA regulatory standards. The ability to meet these criteria was classified as either full, partial or no evidence, whereby partial reflected some evidence but not enough to comprehensively address the FDA regulatory standards. Most instruments provided partial evidence of content validity. Input from clinicians and literature was common although few involved patients in both item generation and cognitive debriefing. Construct validity was predominantly compromised by no evidence of a-priori hypotheses of expected relationships. Evidence for test-retest reliability and internal consistency was available for most PROs although few included complete results regarding all subscales and some failed to reach recommended thresholds. The ability to detect change and interpretation of change were not investigated in most instruments and no PROs had published evidence of a conceptual framework. The study concludes that none of the 26 have the full evidence required by the FDA to support a label claim, and all require further research to support their use as an endpoint. The Subjective Handicap of Epilepsy (SHE) and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) have the fewest gaps that would need to be addressed through additional research prior to any FDA regulatory submission, although the NDDI-E was designed as a screening tool and is therefore unlikely to be suitable as an instrument for capturing change in a clinical trial and the SHE lacks the conceptual focus on signs and symptoms favoured by the FDA.
Collapse
Affiliation(s)
- Annabel Nixon
- Oxford Outcomes, an ICON Plc. Company, Seacourt Tower, West Way, Oxford, OX2 0JJ, UK
| | - Cicely Kerr
- Oxford Outcomes, an ICON Plc. Company, Seacourt Tower, West Way, Oxford, OX2 0JJ, UK
| | - Katie Breheny
- Oxford Outcomes, an ICON Plc. Company, Seacourt Tower, West Way, Oxford, OX2 0JJ, UK
| | - Diane Wild
- Oxford Outcomes, an ICON Plc. Company, Seacourt Tower, West Way, Oxford, OX2 0JJ, UK
| |
Collapse
|
18
|
Health-related quality of life in Russian adults with epilepsy: the effect of socio-demographic and clinical factors. Epilepsy Behav 2012; 25:670-5. [PMID: 23158775 DOI: 10.1016/j.yebeh.2012.09.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 09/27/2012] [Accepted: 09/29/2012] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate socio-demographic and clinical factors influencing the health-related quality of life (HRQOL) of adult patients with epilepsy in a naturalistic treatment setting in Russia. METHODS The QOLIE-31 questionnaire and the Beck Depression Inventory (BDI) were completed by 208 patients with a broad clinical spectrum of epilepsy (the mean age was 31.49±13.20 years and ranged from 18 to 74 years). RESULTS In Russian adult patients with epilepsy, lower mean QOLIE-31 scores were obtained compared with previously published international data for overall HRQOL, emotional well-being, and cognitive functioning and social functioning subscales (p<0.001). Univariate analysis revealed that duration of epilepsy negatively correlated with all QOLIE-31 subscores (p<0.05), except for emotional well-being (p=0.1). In multivariate regression analysis, BDI depression score was the predictor of overall score and all QOLIE-31 domains, except for emotional well-being. Age could be considered as a predictor of cognitive and social functioning, medical effects, and the total QOLIE -31 score. Seizure frequency was a factor associated with all HRQOL domains, except for medication effects and emotional well-being, whereas gender, education, family status, seizure type, employment, lateralization of epileptic foci, number of antiepileptic drugs, and the reported adverse events did not significantly affect HRQOL. CONCLUSION The present study has revealed that longer duration of epilepsy, older age, higher seizure frequency, and depression are the potential predictors of worse HRQOL in adult Russian patients with epilepsy.
Collapse
|
19
|
Piazzini A, Bravi F, Edefonti V, Turner K, Vignoli A, Ferraroni M, Canevini MP. Aggressive behavior and epilepsy: A multicenter study. Epilepsia 2012; 53:e174-9. [DOI: 10.1111/j.1528-1167.2012.03643.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Gómez-Arias B, Crail-Meléndez D, López-Zapata R, Martínez-Juárez IE. Severity of anxiety and depression are related to a higher perception of adverse effects of antiepileptic drugs. Seizure 2012; 21:588-94. [PMID: 22776677 DOI: 10.1016/j.seizure.2012.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 06/04/2012] [Accepted: 06/09/2012] [Indexed: 10/28/2022] Open
Abstract
UNLABELLED After reviewing the negative effects of antiepileptic drugs (AEDs) on general health and quality of life, the Commission on Outcome Measurement from the International League Against Epilepsy (ILAE) recommended incorporating reliable and valid tools in clinical essays in order to achieve a more accurate assessment of the subjective adverse effects rate and disease severity when using AEDs. PURPOSE The aim of this study was to correlate the severity of adverse effects of AEDs, with the presence of anxiety and depression in patients with epilepsy. METHODS The Spanish version of the Liverpool Adverse Events Profile (LAEP) and the hospital anxiety and depression scale (HADS) were applied on 130 consecutive outpatients with epilepsy from the epilepsy clinic at the Mexico's National Institute of Neurology and Neurosurgery. A correlation analysis was carried out to determine if the presence of depression and anxiety was related to the adverse effects of AEDs. The relation between LAEP scores with other epidemiological variables was also assessed. RESULTS Our study found a positive correlation between the LAEP and the HADS scores (p < or = 0.01). The most common adverse effects were drowsiness (81.5% [n=106]), difficulty in concentrating (76% [n=99]), and nervousness and/or agitation (75% [n=97]). Female gender, a history of febrile seizures, persistent seizures and polytherapy were associated with a higher toxicity on LAEP. In our study, age at epilepsy onset, duration of epilepsy, type of epilepsy and patients' age were not related to higher LAEP scores. CONCLUSION Adverse effects to AEDs can be related with the presence of psychiatric disorders such as anxiety and depression in patients with epilepsy.
Collapse
Affiliation(s)
- Bety Gómez-Arias
- Clinical Epileptology Fellowship, National Institute of Neurology and Neurosurgery, UNAM, México City, Mexico
| | | | | | | |
Collapse
|
21
|
Disability in elderly patients with chronic neurological illness: Stroke, multiple sclerosis and epilepsy. Arch Gerontol Geriatr 2011; 53:e227-31. [DOI: 10.1016/j.archger.2010.11.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/26/2010] [Accepted: 11/27/2010] [Indexed: 11/18/2022]
|
22
|
Taylor RS, Sander JW, Taylor RJ, Baker GA. Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review. Epilepsia 2011; 52:2168-80. [PMID: 21883177 DOI: 10.1111/j.1528-1167.2011.03213.x] [Citation(s) in RCA: 258] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Given the high burden of epilepsy on both health-related quality of life (HRQoL) and costs, identification of factors that are predictive of either reduced HRQoL or increased expenditure is central to the better future targeting and optimization of existing and emerging interventions and management strategies for epilepsy. METHODS Searches of Medline, Embase, and Cochrane Library (up to July 2010) to identify studies examining the association between demographic, psychosocial, and condition-related factors and HRQoL, resource utilization or costs in adults with epilepsy. For each study, predictor factor associations were summarized on the basis of statistical significance and direction; the results were then combined across studies. KEY FINDINGS Ninety-three HRQoL and 16 resource utilization/cost studies were included. Increases in seizure frequency, seizure severity, level of depression, and level of anxiety and presence of comorbidity were strongly associated with reduced HRQoL. The majority of studies were cross-sectional in design and had an overall methodologic quality that was judged to be "moderate" for HRQoL studies and "poor" for health care resource or costs studies. In the 53 multivariate studies, age, gender, marital status, type of seizure, age at diagnosis, and duration of epilepsy did not appear to be associated with HRQoL, whereas the predictive influence of educational and employment status, number of antiepileptic drugs (AEDs) and AED side effects was unclear. The association between predictive factors and HRQoL appeared to be consistent across individuals whether refractory or seizures controlled or managed by AEDs. There were insufficient multivariate studies (five) to reliably comment on the predictors of resource utilization or cost in epilepsy. SIGNIFICANCE In addition to seizure control, effective epilepsy management requires the early detection of those most at risk of psychological dysfunction and comorbidity, and the targeting of appropriate interventions. There is need for more rigorous studies with appropriate multivariate statistical methods that prospectively investigate the predictors of HRQoL, resource utilization, and costs in epilepsy.
Collapse
Affiliation(s)
- Rod S Taylor
- Peninsula College of Medicine & Dentistry, University of Exeter, Exeter, United Kingdom.
| | | | | | | |
Collapse
|
23
|
A new Italian instrument for the assessment of irritability in patients with epilepsy. Epilepsy Behav 2011; 21:275-81. [PMID: 21624849 DOI: 10.1016/j.yebeh.2011.04.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 04/11/2011] [Accepted: 04/14/2011] [Indexed: 11/22/2022]
Abstract
The purpose of the work described in this article was to analyze the psychometric properties of a new Italian instrument for the assessment of irritability in adult patients with epilepsy (I-Epi). Five hundred four patients from nine secondary and tertiary Italian centers for the care of epilepsy were recruited and interviewed. Each patient was evaluated on a series of demographic and clinical variables recorded before administration of the I-Epi and the AQ (Aggression Questionnaire), used for external validity. The final results supported the reliability and validity of the I-Epi as a measure of irritability in the adult epilepsy population. The psychometric characteristics of the I-Epi seemed fairly good. We believe that adoption of this new instrument could be very useful in both clinical and research management of patients with epilepsy.
Collapse
|
24
|
Edefonti V, Bravi F, Turner K, Beghi E, Canevini MP, Ferraroni M, Piazzini A. Health-related quality of life in adults with epilepsy: the effect of age, age at onset and duration of epilepsy in a multicentre Italian study. BMC Neurol 2011; 11:33. [PMID: 21392391 PMCID: PMC3062600 DOI: 10.1186/1471-2377-11-33] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 03/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The potential effect of age-related factors on health-related quality of life (HRQOL) of patients with epilepsy has rarely been analyzed in the literature. METHODS We examined this association in a selected population of 815 adults with epilepsy recruited in the context of a multicentre study for the evaluation of Epi-QoL, one of the first Italian epilepsy-specific measures of HRQOL for adults with epilepsy. The Epi-QoL is a 46-item self-administered questionnaire focusing on six domains, which was successfully tested for reproducibility and validity. Ordinary least-squares regression models were used to assess the relationships between age-related factors (patient's age, age at seizure onset, and duration of epilepsy) and overall Epi-QoL score, controlling for the effect of potential confounders. We fitted simple regression models including each age-related factor alone to assess the independent role of each factor on the overall Epi-QoL score. We also fitted multiple regression models including pairs of age-related factors solely, as well as one or two age-related factors together with the same set of confounders. RESULTS Simple regression models showed that age and duration of epilepsy were significant negative predictors of the overall Epi-QoL score: the higher was each age-related factor, the lower was the overall Epi-QoL score; age at onset alone was a nonsignificant predictor of the overall Epi-QoL score. Multiple regression models including two age-related factors solely showed that duration of epilepsy was still a significant negative predictor of the overall Epi-QoL score in both pairwise models, whereas age was a significant negative predictor only in the model including age at onset. Age at onset emerged as a significant positive predictor of the overall Epi-QoL score only in the model including age: the higher was age at onset, the higher was the overall Epi-QoL score. Adjusted regression models including either one or two age-related factors and controlling for the selected confounding variables showed that the age-related factors had no significant effect on the overall Epi-QoL score anymore. CONCLUSIONS If no other known correlates of the overall Epi-QoL score are considered, age and duration of epilepsy can be expected to have a significant negative association with HRQOL in epilepsy (with the effect of duration being stronger and more consistent across models than the one of age), whereas age at onset is a positive predictor of the overall HRQOL of limited significance. However, demographic and clinical factors, such as seizure frequency in the preceding 12 months, may provide a better explanation of HRQOL in epilepsy.
Collapse
Affiliation(s)
- Valeria Edefonti
- Sezione di Statistica Medica e Biometria Giulio A. Maccacaro, Dipartimento di Medicina del Lavoro Clinica del Lavoro L. Devoto, Università degli Studi di Milano, Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|
25
|
Viteri C, Codina M, Cobaleda S, Lahuerta J, Barriga J, Morales M. Quality of life and treatment satisfaction in Spanish epilepsy patients on monotherapy with lamotrigine or valproic acid. Seizure 2010; 19:432-8. [DOI: 10.1016/j.seizure.2010.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 06/17/2010] [Indexed: 11/17/2022] Open
|
26
|
Canevini MP, De Sarro G, Galimberti CA, Gatti G, Licchetta L, Malerba A, Muscas G, La Neve A, Striano P, Perucca E. Relationship between adverse effects of antiepileptic drugs, number of coprescribed drugs, and drug load in a large cohort of consecutive patients with drug-refractory epilepsy. Epilepsia 2010; 51:797-804. [PMID: 20545754 DOI: 10.1111/j.1528-1167.2010.02520.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|