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Lesica S, Luu H, Lawrence M. Performance validity in a presurgical epilepsy population. Clin Neuropsychol 2024:1-13. [PMID: 39138860 DOI: 10.1080/13854046.2024.2391128] [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: 03/24/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024]
Abstract
Objective: This study examined the performance validity test (PVT) pass/fail rate in a sample of presurgical epilepsy candidates; assessed whether performance validity was associated with reduced performance across cognitive domains; investigated the relationship between performance validity and self-report mood questionnaires; and assessed whether PVT performance was associated with demographic or clinical factors (i.e. sex, race/ethnicity, age, years of education, reported history of special education, seizure longevity, and number of anti-seizure medications). Methods: One hundred and eighty-three presurgical epilepsy candidates were examined. Each patient's assessment battery included a stand-alone performance validity measure and two embedded validity measures. Results: PVT failure rate in this sample (10%) was associated with reduced performance on all neurocognitive measures: Full Scale IQ (FSIQ; r = -0.26), CVLT-II Total Learning (r = -0.36) and Long Delay Free Recall (LDFR; r = -0.38), BVMT-R Delayed Recall (r = -0.28), and Wisconsin Card Sorting Test (Categories Completed; r = -0.32). In addition, PVT failure rate was associated with elevated scores on the Beck Anxiety Inventory (r = .22) but not on the Beck Depression Inventory (BDI-II; r = .14). Correlations that were significant at the α = 0.05 level maintained significance following post hoc Bonferroni correction. The valid and invalid groups did not differ significantly in sex, race/ethnicity, age, years of education, reported history of special education, seizure longevity, and number of anti-seizure medications. Conclusions: Results from this study suggest that PVT performance was not impacted by demographic or clinical factors and therefore may be a reliable indicator of performance validity in a presurgical epilepsy sample.
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Affiliation(s)
- Sofia Lesica
- Corewell Health, Grand Rapids, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
| | - Hien Luu
- Corewell Health, Grand Rapids, MI, USA
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Dubenko A, Morelli R, Cross JH, Hall J, Kharytonov V, Michaelis R, Wiebe S. Mental health and quality of life of individuals with epilepsy during the war in Ukraine. Epilepsia 2024. [PMID: 38943522 DOI: 10.1111/epi.18052] [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: 04/08/2024] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To investigate the repercussions of the war in Ukraine on people with epilepsy (PWE), focusing on access to health care, seizure control, quality of life (QoL), psychological distress, anxiety, and depression; and to identify the key factors influencing these measures. METHODS Consecutive PWE, ≥18 years of age, presenting to one of seven health centers across Ukraine were invited to complete a self-administered survey in 2023. The survey gathered information on clinical and demographic aspects, geographic displacement, and access to care and medications. It also contained five valid questionnaires exploring psychological distress (Kessler-10), QoL with the EuroQOL-5D-5L (EQ-5D-5L), depression with the Neurological Disorders in Epilepsy scale (NDDIE), anxiety with the Hospital Anxiety and Depression Scalae-Anxiety (HADS-A), and epilepsy severity with the Global Assessment of the Severity of Epilepsy scale (GASE). Multivariate linear regression models assessed the relationship between measures of mental health and QoL and their potential predictors. Ethical approval was obtained from the Institute of Neurology, Psychiatry and Narcology of NAMS of Ukraine, Ukraine. RESULTS Among 305 participants (mean age 38 years), 40% were female and 44% had to change residence because of the war. Seizures worsened during the war in 52% of those with active epilepsy and 42% of those with well-controlled epilepsy. Difficulties accessing health care and anti-seizure medications occurred in 25% and 34% of PWE, respectively, and was worse among those who were displaced. According to the mental health instruments, 46% suffered psychological distress, 62% experienced anxiety, 50% were depressed, and 59% rated their epilepsy as somewhat severe or worse. Statistically significant predictors of psychological distress, anxiety, and depression included female gender, more severe epilepsy, increased seizures during the war, and requiring mental health support. SIGNIFICANCE The war significantly disrupted access to health care and availability of medication in PWE, who suffer from significant anxiety, depression, and psychological distress. We identify high-risk factors that can guide resource allocation for prevention and treatment.
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Affiliation(s)
- Andriy Dubenko
- Institute of Neurology, Psychiatry and Narcology of NAMS of Ukraine, Kharkov, Ukraine
| | | | - J Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Julie Hall
- International League Against Epilepsy, Washington, DC, USA
| | | | - Rosa Michaelis
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Whitfield A, Leighton E, Boagey H, Oto M. Dual diagnosis of epilepsy and dissociative seizures: Prescription patterns, feasibility and safety of rationalising antiseizure medication. Epilepsy Behav 2024; 152:109661. [PMID: 38277845 DOI: 10.1016/j.yebeh.2024.109661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Patients with a dual-diagnosis of epilepsy and dissociative seizures (DS) have received far less attention than those with single pathology. Anti-seizure medication (ASM) prescription patterns and safety of rationalisation have not been reviewed. METHODS We undertook a retrospective cohort study of all patients with a dual-diagnosis admitted to the Scottish Epilepsy Centre between 2012-2020. ASM frequencies were compared across admission, discharge and follow-up and emergency hospital attendances compared a year before and after admission. Demographic data, seizure characteristics and mortality data were also reviewed. RESULTS Across the 139 patients included in our study, ASM frequency at follow-up was significantly lower than on admission (mean 2.51 vs 2.14, Z = -2.11 p = 0.035, r = -0.215). Total hospital attendances in the year following admission were significantly lower than in the year before (mean 1.27 vs 0.77, Z = 2.306, p = 0.021, r = -0.262). Those with inactive epilepsy had their medications reduced to a greater extent that those with active epilepsy. 44 patients had their ASM frequency reduced during admission with a similar trend of reduced hospital attendances (mean 1.29 vs 0.43 Z = -3.162 p = 0.002). There was one epilepsy related death. CONCLUSIONS Clinicians should consider the development of co-morbid DS in patients with epilepsy not responding to an escalation of ASM, especially if presenting with a new seizure type. Patients with a dual-diagnosis of epilepsy and DS, particularly those with well controlled epilepsy, are likely overtreated with ASM. Medication review in a tertiary epilepsy centre allows for safe rationalisation of ASM and likely contributes to the need for fewer hospital attendances.
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Affiliation(s)
- Andrew Whitfield
- Department of Neurology, St George's University Hospital, London, UK.
| | - Emma Leighton
- Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - Heather Boagey
- Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - Maria Oto
- Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK; William Quarrier Scottish Epilepsy Centre, Glasgow, UK
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Roghani A, Bouldin E, Mobasher H, Kalvesmaki A, Panahi S, Henion A, VanCott A, Raquel Lopez M, Jo Pugh M. COVID-19 pandemic experiences among people with epilepsy: Effect on symptoms of co-occurring health conditions and fear of seizure. Epilepsy Behav 2023; 144:109206. [PMID: 37236022 DOI: 10.1016/j.yebeh.2023.109206] [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: 01/13/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The Coronavirus disease 2019 (COVID-19) pandemic profoundly affected people worldwide, but little is known about how it impacted people with epilepsy (PWE). We examined the associations between COVID-19 stressors and health outcomes including increases in other health symptoms and fear of seizure among PWE. METHODS This cross-sectional study used data from an online survey that asked about demographic characteristics, health conditions, and potential life stressors during COVID-19. Data were collected from October 30 to December 8, 2020. COVID-19 stressors were anger, anxiety, stress, healthcare access, fear of seeking healthcare, social isolation, sense of control over their lives, and alcohol consumption. A binary variable was created for each of these measures to indicate whether PWEs experienced a negative change versus a neutral or positive change. We used multivariable logistic regression to assess the associations of COVID-19 stressors with primary outcomes: exacerbated co-occurring health conditions and increasing fear of seizure during the pandemic. RESULTS Of the 260 PWE included in the study, 165 (63.5%) were women; the average age was 38.7 years. During the survey administration period, 79 (30.3%) of the respondents reported exacerbated co-occurring health conditions, and 94 (36.2%) reported an increased fear of seizures. Regression results indicated that the fear of seeking healthcare during COVID-19 was associated with both exacerbated co-occurring health conditions (aOR 1.12; 95%CI 1.01-1.26) and increasing fear of seizure (aOR 2.31; 95%CI 1.14-4.68). Social isolation was associated with exacerbated co-occurring health conditions during COVID-19 (aOR 1.14; 95%CI 1.01-1.29). Reduced access to physical healthcare was associated with increasing fear of seizure (aOR 2.58; 95%CI 1.15-5.78). CONCLUSION A considerable number of PWE experienced more symptoms of existing health conditions and fear of seizure during the initial year of the pandemic (2020). Fear of seeking healthcare services was associated with both negative outcomes. Assuring access to health care and reducing social isolation could potentially reduce negative outcomes for PWE. It is necessary to provide adequate support for PWE to reduce risks as COVID-19 continues to be a health concern.
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Affiliation(s)
- Ali Roghani
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin Bouldin
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Helal Mobasher
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrea Kalvesmaki
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Samin Panahi
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Amy Henion
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anne VanCott
- VA Pittsburgh Health Care System, Pittsburgh, PA, USA; Department of Neurology, Epilepsy Division University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Raquel Lopez
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Jo Pugh
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Perceived stigma in adults with epilepsy in Sweden and associations with country of birth, socioeconomic status, and mental health. Epilepsy Behav 2022; 136:108886. [PMID: 36152384 DOI: 10.1016/j.yebeh.2022.108886] [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: 05/19/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stigma contributes to negative health outcomes and amplifies health disparities in epilepsy. This study aimed to investigate associations of perceived stigma with the country of birth and socioeconomic status (SES). METHODS This is a cross-sectional questionnaire study. Participants were recruited consecutively from three demographically different neurology outpatient clinics in the southwest of Sweden. Participants responded to a questionnaire concerning their epilepsy, country of birth, mother tongue, and different SES-variables. The Neuro-QOL stigma scale and the Jacoby stigma scale were applied to assess stigma and the Hospital Anxiety and Depression Scale (HADS) and PROMIS Mental Health scale were applied to assess mental health. RESULTS In total 161 adults with epilepsy were included in the cohort. The median Neuro-QOL stigma score was 48.3, and was higher among foreign-born than in native-born participants (foreign-born in non-European country 52.3, in other European country 49.8, and in native-born 47.0, p = 0.003). Other factors associated with Neuro-QOL were seizure frequency last year (≥2 seizures 52.4 compared to 1 seizure 50.9 and no seizures 44.3, p < 0.001), having had seizures in public (yes 50.9 compared to no 44.7, p = 0.035), HADS depression score ≥11 (57.4 compared to 47.8 for score <11 points, p < 0.001), HADS anxiety score ≥11 (53.5 compared to 46.8 for score <11 points, p < 0.001), and lower PROMIS Mental Health score (42.9 for PROMIS < 40 compared to 54.4 for PROMIS > 60, p < 0.01). A stepwise multiple regression analysis indicated that having had seizures the last year increased the average Neuro-QOL stigma score with 5.89 and appeared as the most determining factor for the Neuro-QOL stigma score among the variables investigated. CONCLUSIONS It is important that the concerns of foreign-born patients are acknowledged and that the focus of seizure control and the detection and treatment of comorbidities are prioritized in the management of epilepsy and perceived stigma.
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Dalic LJ, Warren AE, Malpas CB, Thevathasan W, Roten A, Bulluss KJ, Archer JS. Cognition, adaptive skills and epilepsy disability/severity in patients with Lennox–Gastaut syndrome undergoing deep brain stimulation for epilepsy in the ESTEL trial. Seizure 2022; 101:67-74. [DOI: 10.1016/j.seizure.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/25/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022] Open
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Lin PT, Wiebe S, Chou CC, Lu YJ, Lin CF, Hsu SPC, Lee CC, Yu HY. Validation of the Taiwanese version of the Epilepsy Surgery Satisfaction Questionnaire (Tw-ESSQ-19). Epilepsy Behav 2022; 133:108768. [PMID: 35714564 DOI: 10.1016/j.yebeh.2022.108768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/22/2022] [Accepted: 05/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Satisfaction with epilepsy surgery in Mandarin-speaking countries remains unknown. We aimed to validate in our Taiwanese patients an existing instrument to measure patient satisfaction with epilepsy surgery, the 19-item Epilepsy Surgery Satisfaction Questionnaire (ESSQ-19). METHODS Consecutive patients with epilepsy who received epilepsy surgery one year earlier in Taipei Veterans General Hospital were recruited and provided clinical and demographic data. The Mandarin version of the ESSQ-19 for the Taiwanese population and eight other questionnaires were completed to assess construct validity. To evaluate the validity and reliability of the tool, the data were analyzed by confirmatory factor analysis, Spearman's rank correlation, and internal consistency analysis. RESULTS The study involved 120 patients (70 F/50 M, median age 35 years [IQR = 28-41]). The mean summary score (±SD) of the Tw-ESSQ-19 was 82.5 ± 14.5. The mean scores of the four domains were 90.3 ± 15.4 (surgical complications), 83.2 ± 16.7 (seizure control), 80.1 ± 17.3 (recovery from surgery), and 76.6 ± 18.3 (psychosocial functioning). The questionnaire was shown to have good construct validity with satisfactory goodness-of-fit of the data (standardized root mean square residual = 0.0492; comparative fit index = 0.946). It also demonstrated good discriminant validity (being seizure free [AUC 0.78; 95% CI 0.68-0.89], endorsing depression [AUC 0.84; 95% CI 0.76-0.91], self-rating epilepsy as disabling [AUC 0.71; 95% CI 0.58-0.84], and self-rating epilepsy as severe [AUC 0.78; 95% CI 0.64-0.93]), high internal consistency in four domains (Cronbach's alpha = 0.83-0.96), and no significant floor/ceiling effects of the summary score. SIGNIFICANCE The Mandarin version of the ESSQ-19 adapted for the Taiwanese population is a reliable and valid self-reported questionnaire for assessing patient satisfaction with epilepsy surgery.
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Affiliation(s)
- Po-Tso Lin
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Chien-Chen Chou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Jiun Lu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sanford P C Hsu
- Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Wahby S, Lawal OA, Sajobi TT, Keezer M, Nguyen DK, Malmgren K, Atkinson MJ, Hader WJ, Josephson CB, Macrodimitris S, Patten S, Pillay N, Sharma R, Singh S, Starreveld Y, Wiebe S. Validity and reliability of global ratings of satisfaction with epilepsy surgery. Epilepsia 2022; 63:777-788. [DOI: 10.1111/epi.17184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/30/2021] [Accepted: 01/27/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Sandra Wahby
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Oluwaseyi A. Lawal
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Tolulope T. Sajobi
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
- O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
| | - Mark R. Keezer
- Department of Neurosciences Université de Montreal Montreal Quebec Canada
| | - Dang K. Nguyen
- Department of Neurosciences Université de Montreal Montreal Quebec Canada
| | - Kristina Malmgren
- Institute of Neuroscience and Physiology Sahlgrenska Academy at Gothenburg University and Sahlgrenska University Hospital Gothenburg Sweden
| | - Mark J. Atkinson
- Family Medicine and Public Health University of California San Diego California USA
| | - Walter J. Hader
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Colin B. Josephson
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
- O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
| | - Sophia Macrodimitris
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Scott B. Patten
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
- O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
- Department of Psychiatry Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Neelan Pillay
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Ruby Sharma
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Shaily Singh
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
- O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
| | - Yves Starreveld
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
- O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
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Wang M, Perera K, Josephson CB, Lamidi M, Lawal OA, Awosoga O, Roach P, Patten SB, Wiebe S, Sajobi TT. Association between antiseizure medications and quality of life in epilepsy: A mediation analysis. Epilepsia 2021; 63:440-450. [PMID: 34931300 DOI: 10.1111/epi.17153] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/29/2021] [Accepted: 12/08/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The relationship between antiseizure medications (ASMs), which improve health outcomes by controlling seizures, and health-related quality of life (HRQOL) is poorly understood and may involve intermediate variables. We evaluated the potential mediators of the association between ASMs and HRQOL. METHODS Data are from an outpatient registry of adult patients with epilepsy seen at the Foothills Medical Center, Calgary, Alberta, Canada. Quality of life was measured using the 10-item Quality of Life in Epilepsy, and depression was measured using the Neurological Disorders Depression Inventory for Epilepsy. Propensity score matching was used to adjust for covariate imbalance between patients who received a single ASM (monotherapy) and those who received two or more ASMs (polytherapy) due to confounding. Mediation analysis was used to estimate the mediating effects of depression and ASM side effects on the association between patients' ASM polytherapy and HRQOL. RESULTS Of 778 patients included in this analysis, 274 (35.2%) were on two or more ASMs. Patient-reported depression and ASM side effects jointly mediated the association between ASMs and HRQOL; these mediators accounted for 42% of the total average effect of ASM polytherapy ( β = -13.6, 95% confidence interval = -18.2 to -8.6) on HRQOL. SIGNIFICANCE These findings highlight the importance of managing depression and ASM side effects for improving health outcomes of patients requiring treatment with ASMs. Intervention programs aimed at improving HRQOL of patients with epilepsy need to target these potential mediators.
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Affiliation(s)
- Meng Wang
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Perera
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Colin B Josephson
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mubasiru Lamidi
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Oluwaseyi A Lawal
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Pamela Roach
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Tedrus GMAS, Augusto MN, Bonolo HPB. Perception of seizure severity and bothersome in refractory focal epilepsy. Rev Neurol (Paris) 2021; 178:603-608. [PMID: 34920892 DOI: 10.1016/j.neurol.2021.10.005] [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: 06/28/2021] [Revised: 08/24/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A better understanding of the perception of the severity and bothersome caused by seizure phases (warning, ictal, and postictal phases) can contribute to the orientation strategies for adult people with epilepsy (PWEs). OBJECTIVE To assess the seizure severity and bothersome and relate them to the clinical aspects of epilepsy and quality of life (QoL). METHODS The Seizure Severity Questionnaire (SSQ) was associated with clinical variables and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the QOLIE-31 of 98 PWEs, with a significance level of P<0.05. RESULTS Most patients reported that seizure warnings helped them prepare for the event, with the postictal phase was the most bother symptom. Higher scores on the SSQ were associated with movements in the ictal phase, a prolonged duration, and the presence of mental and physical effects in the postictal phase. No difference was found in the SSQ, according to the seizure type and frequency. There was an association between the NDDI-E>15 and the SSQ. Higher scores on the SSQ were significantly related to an NDDI-E>15 (P=0.013), in the linear regression model. Seizure severity and bothersome compromise the perception of QoL. CONCLUSION The SSQ was useful in the assessment of the perception of seizure severity in PWEs. The postictal phase was the most bothersome one. The perception of seizure severity is associated with the presence of depression. Seizure severity correlates inversely with QoL.
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Affiliation(s)
- G M A S Tedrus
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, São Paulo, Brazil.
| | - M N Augusto
- School of Medicine, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, São Paulo, Brazil
| | - H P B Bonolo
- School of Medicine, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, São Paulo, Brazil
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11
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Dalic LJ, Warren AEL, Bulluss KJ, Thevathasan W, Roten A, Churilov L, Archer JS. DBS of Thalamic Centromedian Nucleus for Lennox-Gastaut Syndrome (ESTEL Trial). Ann Neurol 2021; 91:253-267. [PMID: 34877694 DOI: 10.1002/ana.26280] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/22/2021] [Accepted: 12/05/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Prior uncontrolled studies have reported seizure reductions following deep brain stimulation (DBS) in patients with Lennox-Gastaut syndrome (LGS), but evidence from randomized controlled studies is lacking. We aimed to formally assess the efficacy and safety of DBS to the centromedian thalamic nucleus (CM) for the treatment of LGS. METHODS We conducted a prospective, double-blind, randomized study of continuous, cycling stimulation of CM-DBS, in patients with LGS. Following pre- and post-implantation periods, half received 3 months of stimulation (blinded phase), then all received 3 months of stimulation (unblinded phase). The primary outcome was the proportion of participants with ≥50% reduction in diary-recorded seizures in stimulated versus control participants, measured at the end of the blinded phase. A secondary outcome was the proportion of participants with a ≥50% reduction in electrographic seizures on 24-hour ambulatory electroencephalography (EEG) at the end of the blinded phase. RESULTS Between November 2017 and December 2019, 20 young adults with LGS (17-37 years;13 women) underwent bilateral CM-DBS at a single center in Australia, with 19 randomized (treatment, n = 10 and control, n = 9). Fifty percent of the stimulation group achieved ≥50% seizure reduction, compared with 22% of controls (odds ratio [OR] = 3.1, 95% confidence interval [CI] = 0.44-21.45, p = 0.25). For electrographic seizures, 59% of the stimulation group had ≥50% reduction at the end of the blinded phase, compared with none of the controls (OR= 23.25, 95% CI = 1.0-538.4, p = 0.05). Across all patients, median seizure reduction (baseline vs study exit) was 46.7% (interquartile range [IQR] = 28-67%) for diary-recorded seizures and 53.8% (IQR = 27-73%) for electrographic seizures. INTERPRETATION CM-DBS in patients with LGS reduced electrographic rather than diary-recorded seizures, after 3 months of stimulation. Fifty percent of all participants had diary-recorded seizures reduced by half at the study exit, providing supporting evidence of the treatment effect. ANN NEUROL 2021.
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Affiliation(s)
- Linda J Dalic
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, VIC, Australia.,Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Aaron E L Warren
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Kristian J Bulluss
- Bionics Institute, East Melbourne, VIC, Australia.,Department of Neurosurgery, Austin Health, Heidelberg, VIC, Australia.,Department of Surgery, University of Melbourne, Parkville, VIC, Australia
| | - Wesley Thevathasan
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, VIC, Australia.,Bionics Institute, East Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, and Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Annie Roten
- Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, VIC, Australia
| | - John S Archer
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, VIC, Australia.,Department of Neurology, Austin Health, Heidelberg, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
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12
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Delgado-García G, Wiebe S, Josephson CB. The use of patient-reported measures in epilepsy care: the Calgary Comprehensive Epilepsy Program experience. J Patient Rep Outcomes 2021; 5:83. [PMID: 34636998 PMCID: PMC8505782 DOI: 10.1186/s41687-021-00356-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The regular use of patient-reported measures (PRMs) has been associated with greater patient satisfaction and outcomes. In this article, we will review the Calgary Comprehensive Epilepsy Program's successful experience with PRMs in both clinical and research settings, as well as our current challenges and future directions. Our experience will illustrate that is feasible and convenient to implement PRMs, and especially electronic PRMs (ePRMs), into epilepsy clinics. These PRMs have direct clinical and research applications. They inform clinical decision making through readily interpretable scales to which clinicians can expeditiously respond. Equally, they are increasingly forming an integral and central component of intervention and outcomes-based research. However, implementation studies are necessary to address knowledge gaps and facilitate adoption and dissemination of this approach. A natural symbiosis of the clinical and research realms is precision medicine. The foundations of precision-based interventions are now being set whereby we can maximize the quality of life and psychosocial functioning on an individual level. As illustrated in this article, this exciting prospect crucially depends on the routine use of ePRMs in the everyday care of people with epilepsy. Increasing ePRMs uptake will clearly be a catalyst propelling precision epilepsy from aspiration to clinical reality.
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Affiliation(s)
- Guillermo Delgado-García
- Department of Clinical Neurosciences, Cumming School of Medicine, Foothills Medical Centre, University of Calgary, 1403 - 29 St NW, Calgary, AB, Canada.,Centro de Investigación y Desarrollo en Ciencias de la Salud (CIDICS), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, Foothills Medical Centre, University of Calgary, 1403 - 29 St NW, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Clinical Research Unit, University of Calgary, Calgary, AB, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, Foothills Medical Centre, University of Calgary, 1403 - 29 St NW, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. .,Centre for Health Informatics, University of Calgary, Calgary, AB, Canada.
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13
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Severity and disability related to epilepsy from the perspective of patients and physicians: A cross-cultural adaptation of the GASE and GAD scales. Seizure 2021; 90:93-98. [DOI: 10.1016/j.seizure.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/22/2022] Open
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14
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Josephson CB, Engbers JDT, Sajobi TT, Wahby S, Lawal OA, Keezer MR, Nguyen DK, Malmgren K, Atkinson MJ, Hader WJ, Macrodimitris S, Patten SB, Pillay N, Sharma R, Singh S, Starreveld Y, Wiebe S. Predicting postoperative epilepsy surgery satisfaction in adults using the 19-item Epilepsy Surgery Satisfaction Questionnaire and machine learning. Epilepsia 2021; 62:2103-2112. [PMID: 34245019 DOI: 10.1111/epi.16992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The 19-item Epilepsy Surgery Satisfaction Questionnaire (ESSQ-19) is a validated and reliable post hoc means of assessing patient satisfaction with epilepsy surgery. Prediction models building on these data can be used to counsel patients. METHODS The ESSQ-19 was derived and validated on 229 patients recruited from Canada and Sweden. We isolated 201 (88%) patients with complete clinical data for this analysis. These patients were adults (≥18 years old) who underwent epilepsy surgery 1 year or more prior to answering the questionnaire. We extracted each patient's ESSQ-19 score (scale is 0-100; 100 represents complete satisfaction) and relevant clinical variables that were standardized prior to the analysis. We used machine learning (linear kernel support vector regression [SVR]) to predict satisfaction and assessed performance using the R2 calculated following threefold cross-validation. Model parameters were ranked to infer the importance of each clinical variable to overall satisfaction with epilepsy surgery. RESULTS Median age was 41 years (interquartile range [IQR] = 32-53), and 116 (57%) were female. Median ESSQ-19 global score was 68 (IQR = 59-75), and median time from surgery was 5.4 years (IQR = 2.0-8.9). Linear kernel SVR performed well following threefold cross-validation, with an R2 of .44 (95% confidence interval = .36-.52). Increasing satisfaction was associated with postoperative self-perceived quality of life, seizure freedom, and reductions in antiseizure medications. Self-perceived epilepsy disability, age, and increasing frequency of seizures that impair awareness were associated with reduced satisfaction. SIGNIFICANCE Machine learning applied postoperatively to the ESSQ-19 can be used to predict surgical satisfaction. This algorithm, once externally validated, can be used in clinical settings by fixing immutable clinical characteristics and adjusting hypothesized postoperative variables, to counsel patients at an individual level on how satisfied they will be with differing surgical outcomes.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
| | | | - Tolulope T Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sandra Wahby
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oluwaseyi A Lawal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark R Keezer
- Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada
| | - Dang K Nguyen
- Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada
| | - Kristina Malmgren
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mark J Atkinson
- Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
| | - Walter J Hader
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sophia Macrodimitris
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neelan Pillay
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruby Sharma
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shaily Singh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yves Starreveld
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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15
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Wiebe S, Wahby S, Lawal OA, Sajobi TT, Keezer MR, Nguyen DK, Malmgren K, Tellez‐Zenteno J, Atkinson MJ, Hader WJ, Josephson CB, Macrodimitris S, Patten SB, Pillay N, Sharma R, Singh S, Starreveld Y. Development and validation of the Epilepsy Surgery Satisfaction Questionnaire (ESSQ‐19). Epilepsia 2020; 61:2729-2738. [DOI: 10.1111/epi.16709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Samuel Wiebe
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- O'Brien Institute for Public Health University of Calgary Calgary AB Canada
| | - Sandra Wahby
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Oluwaseyi A. Lawal
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Tolulope T. Sajobi
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- O'Brien Institute for Public Health University of Calgary Calgary AB Canada
| | - Mark R. Keezer
- Department of Neurosciences University of Montreal Montreal QC Canada
| | - Dang K. Nguyen
- Department of Neurosciences University of Montreal Montreal QC Canada
| | - Kristina Malmgren
- Institute of Neuroscience and Physiology Sahlgrenska Academy at Gothenburg University and Sahlgrenska University Hospital Gothenburg Sweden
| | | | - Mark J. Atkinson
- Family Medicine and Public Health University of California, San Diego San Diego CA USA
| | - Walter J. Hader
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Colin B. Josephson
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- O'Brien Institute for Public Health University of Calgary Calgary AB Canada
| | - Sophia Macrodimitris
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Scott B. Patten
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- O'Brien Institute for Public Health University of Calgary Calgary AB Canada
- Department of Psychiatry Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Neelan Pillay
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Ruby Sharma
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Shaily Singh
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- O'Brien Institute for Public Health University of Calgary Calgary AB Canada
| | - Yves Starreveld
- Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary AB Canada
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16
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Witt JA, Nass RD, Baumgartner T, von Wrede R, Elger CE, Surges R, Helmstaedter C. Does the accumulated antiepileptic drug load in chronic epilepsy reflect disease severity? Epilepsia 2020; 61:2685-2695. [PMID: 33058192 DOI: 10.1111/epi.16720] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To ascertain factors that are related to the antiepileptic drug load in epilepsy. METHODS In this cross-sectional study, we analyzed a large cohort of conservatively treated patients with epilepsy (n = 1135) and a smaller homogeneous group of presurgical patients with neuropathologically confirmed unilateral hippocampal sclerosis (n = 91). Considered clinical variables comprised (1) presence of an underlying cerebral lesion, (2) onset and (3) duration of epilepsy, (4) seizure frequency, (5) generalized or focal to bilateral tonic-clonic seizures, (6) ictal impairment of awareness, and (7) a history of convulsive status epilepticus. In the presurgical sample, we additionally considered (8) the degree of pathology (hippocampal neuronal cell densities) instead of (1) presence of a cerebral lesion and (9) an overall rating of epilepsy severity (GASE scale). Drug load was quantified as (a) the number of concomitant antiepileptic drugs (AEDs) and (b) the total defined daily dose (DDD). RESULTS Analyses disclosed only small correlations between clinical variables and drug load indices. In the conservatively treated cohort, the multiple regression analyses revealed that epilepsy onset, cerebral lesion, history of convulsive status epilepticus, and seizure frequency combined explained only 6%-10% of variance in drug load. Nearly the same variance (5%-8%) could be explained by duration of epilepsy alone. Degree of hippocampal pathology and the epilepsy severity ratings were not related to drug load indices. SIGNIFICANCE Clinical markers of epilepsy severity were only marginally associated with drug load. Findings rather indicate that patients seem to accumulate drugs due to the chronicity of epilepsy. Overall, the drug load remained largely unexplained. The findings nevertheless call for scrutinizing multidrug therapies in patients with long-lasting epilepsies.
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Affiliation(s)
| | - Robert D Nass
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Tobias Baumgartner
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
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17
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Dewar SR, Heilemann MV, Engel J, Lee EE, Pieters HC. Perceptions of illness severity in adults with drug-resistant temporal lobe epilepsy. Epilepsy Behav 2020; 109:107091. [PMID: 32417384 DOI: 10.1016/j.yebeh.2020.107091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to explore how subjective perceptions of illness severity were described by a sample of participants with drug-resistant epilepsy (DRE) who were considering surgery. METHODS A qualitative methodology, constructivist grounded theory, guided all aspects of the study. Data were collected via 51 semi-structured interviews with 35 adults in our multiethnic sample. At interview, the 20 women (57%) and 15 men (43%) ranged in age from 18 to 68 years (mean = 35.6 years) and had lived with epilepsy for an average of 15.4 y (range = 2-44 years). RESULTS A grounded theory with four interrelated categories was developed to reflect the process by which participants arrived at an explanation of illness severity. Illness severity for participants evolved as participants reflected upon the burdensome impact of uncontrolled seizures on self and others. Epilepsy, when compared with other chronic conditions, was described as less serious, and participants imagined that other peoples' seizures were comparatively worse than their own. Illness severity was not uppermost in participants' minds but emerged as a concept that was both relative and linked to social burden. Perceptions of overall disease severity expanded upon determinants of seizure severity to offer a more complete explanation of what patients themselves did about longstanding, uncontrolled epilepsy. CONCLUSIONS Perceptions of illness severity played a vital role in treatment decision-making with the potential to impact the illness trajectory. How to measure components of illness severity represents a new challenge for outcomes research in DRE.
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Affiliation(s)
- Sandra R Dewar
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
| | - MarySue V Heilemann
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Jerome Engel
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Neurobiology, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States of America; The Brain Research Institute, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Eunice E Lee
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Huibrie C Pieters
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States of America
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18
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Josephson CB, Engbers JDT, Wang M, Perera K, Roach P, Sajobi TT, Wiebe S. Psychosocial profiles and their predictors in epilepsy using patient-reported outcomes and machine learning. Epilepsia 2020; 61:1201-1210. [PMID: 34080185 DOI: 10.1111/epi.16526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To apply unsupervised machine learning to patient-reported outcomes to identify clusters of epilepsy patients exhibiting unique psychosocial characteristics. METHODS Consecutive outpatients seen at the Calgary Comprehensive Epilepsy Program outpatient clinics with complete patient-reported outcome measures on quality of life, health state valuation, depression, and epilepsy severity and disability were studied. Data were acquired at each patient's first clinic visit. We used k-means++ to segregate the population into three unique clusters. We then used multinomial regression to determine factors that were statistically associated with patient assignment to each cluster. RESULTS We identified 462 consecutive patients with complete patient-reported outcome measure (PROM) data. Post hoc analysis of each cluster revealed one reporting elevated measures of psychosocial health on all five PROMs ("high psychosocial health" cluster), one with intermediate measures ("intermediate" cluster), and one with poor overall measures of psychosocial health ("poor psychosocial health" cluster). Failing to achieve at least 1 year of seizure freedom (relative risk [RR] = 4.34, 95% confidence interval [CI] = 2.13-9.09) predicted placement in the "intermediate" cluster relative to the "high" cluster. In addition, failing to achieve seizure freedom, social determinants of health, including the need for partially or completely subsidized income support (RR = 6.10, 95% CI = 2.79-13.31, P < .001) and inability to drive (RR = 4.03, 95% CI = 1.6-10.00, P = .003), and a history of a psychiatric disorder (RR = 3.16, 95% CI = 1.46-6.85, P = .003) were associated with the "poor" cluster relative to the "high" cluster. SIGNIFICANCE Seizure-related factors appear to drive placement in the "intermediate" cluster, with social determinants driving placement in the "poor" cluster, suggesting a threshold effect. Precision intervention based on cluster assignment, with an initial emphasis on improving social support and careful titration of medications for those reporting the worst psychosocial health, could help optimize health for patients with epilepsy.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
| | | | - Meng Wang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Pamela Roach
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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19
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Beilharz JE, Thayer Z, Nikpour A, Lah S. Accelerated long-term forgetting is not evident in adults with genetic generalized epilepsy irrespective of the paradigm used. Epilepsy Behav 2020; 104:106920. [PMID: 32035340 DOI: 10.1016/j.yebeh.2020.106920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/10/2020] [Accepted: 01/17/2020] [Indexed: 10/24/2022]
Abstract
Accelerated long-term forgetting (ALF) is a recently discovered memory disorder characterized by intact acquisition and retention over short delays, followed by abnormally fast rates of forgetting. Accelerated long-term forgetting has been repeatedly found in children, but not in adults, with genetic generalized epilepsy (GGE). It is possible that this discrepancy is due to a difference in paradigms used in these studies. The current study aimed to determine whether adults with GGE displayed ALF using two paradigms, one that required complete learning and another one that did not. In addition, we explored the relationships with everyday memory difficulties, working memory, mood, and epilepsy variables. Fourteen adults with GGE were compared with 16 healthy controls on two verbal memory tests: a modified version of the California Verbal Learning Test learned to a criterion of 100% (complete learning) and Logical Memory from the Wechsler Memory Scale (Fourth Edition) presented only once (incomplete learning). Recall was tested at 2 min, 30 min, and 1 week, and recognition at 1 week only. Working memory, everyday memory, and mood were also assessed. We found no evidence of ALF on either of the two verbal memory paradigms on recall or recognition tests although patients displayed significantly poorer working memory. Moreover, patients with GGE reported significantly more memory difficulties in everyday life, and these were associated with greater mood disturbances but not with memory tests scores. Greater number of antiepileptic drugs and epilepsy severity also related to memory scores on some tests. Our study suggests that a difference in paradigms used to investigate ALF in children and adults with GGE is unlikely to explain the differences in findings. The study tentatively raises a hypothesis that developmental factors may play a role in ALF in patients with GGE; children with GGE may grow out of ALF. Nevertheless, this hypothesis would need to be tested in a longitudinal study that would follow patients from childhood to early adulthood.
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Affiliation(s)
| | - Zoe Thayer
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Armin Nikpour
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia.
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20
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Gil‐Nagel A, Álvarez Carriles J, Bermejo P, Carreño M, García‐Morales I, García Peñas JJ, López‐González FJ, Ruíz‐Falcó M, Sánchez JC, Tato C. Consensus statement for the management of generalized tonic-clonic seizures in Spain. Acta Neurol Scand 2020; 141:22-32. [PMID: 31529468 DOI: 10.1111/ane.13169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/08/2019] [Accepted: 09/10/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop recommendations for the management of patients with primary or secondary generalized tonic-clonic seizures (GTCS) based on best evidence and experience. METHODS The Delphi methodology was followed. A multidisciplinary panel of 10 experts was established, who defined the scope, users and preliminary recommendations. Systematic and narrative reviews of the current literature were performed to assess data on the risk of sudden unexpected death in epilepsy and the efficacy and safety of add-on therapy in patients with GTCS. Twenty-five definitive recommendations were generated which were then graded on a scale of 1 (totally disagree) to 10 (totally agree) by the experts and 45 neurologists. Consensus was reached if at least 70% of the participants applied a score of ≥7. Each recommendation was then assigned a level of evidence, a grade of agreement and a grade of recommendation. The entire process was supervised by an expert methodologist. RESULTS Overall, 24 out of 25 recommendations achieved consensus. These included specific recommendations on diagnosis, evaluation and treatment. The recommendations also emphasized the importance of proper psychological evaluation and effective communication between patients and health professionals, and the importance of patient and family education and support. SIGNIFICANCE The recommendations generated by this consensus can be used as a guide for the diagnosis and management of patients with GTCS.
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Affiliation(s)
| | | | | | - Mar Carreño
- Hospital Clinic de Barcelona Barcelona Spain
| | | | | | | | | | - Juan Carlos Sánchez
- Complejo Hospitalario Universitario Parque Tecnológico de la Salud Granada Spain
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21
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Garofalo DC, Sorge ST, Hesdorffer DC, Winawer MR, Phelan JC, Chung WK, Ottman R. Genetic attribution and perceived impact of epilepsy in multiplex epilepsy families. Epilepsia 2019; 60:2286-2293. [PMID: 31587270 PMCID: PMC7144879 DOI: 10.1111/epi.16352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/09/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Studies have found that affected individuals who believe the cause of their disorder is genetic may react in various ways, including optimism for improved treatments and pessimism due to perceived permanence of the condition. This study assessed the psychosocial impact of genetic attribution among people with epilepsy. METHODS Study participants were 165 persons with epilepsy from multiplex epilepsy families who completed a self-administered survey. Psychosocial impact of epilepsy was assessed with the Impact of Epilepsy Scale, containing items about relationships, employment, overall health, self-esteem, and standard of living. Genetic attribution was assessed using a scale derived from three items asking about the role of genetics in causing epilepsy in the family, the chance of having an epilepsy-related mutation, and the influence of genetics in causing the participant's epilepsy. We estimated prevalence ratios (PRs) for impact of epilepsy above the median using Poisson regression with robust standard errors, adjusting for number of lifetime seizures and time since last seizure. RESULTS Participants' age averaged 51 years; 87% were non-Hispanic white, 63% were women, and 54% were college graduates. The genetic attribution scale was significantly associated with having a high impact of epilepsy (adjusted PR = 1.4, 95% confidence interval = 1.07-1.91, P = .02). One of the three genetic attribution questions was also significantly associated with a high impact of epilepsy (belief that genetics had a big role in causing epilepsy in the family, adjusted PR = 1.8). SIGNIFICANCE These findings reflect an association between the psychosocial impact of epilepsy and the belief that epilepsy has a genetic cause, among people with epilepsy in families containing multiple affected individuals. This association could arise either because belief in a genetic cause leads to increased psychosocial impacts, or because a greater psychosocial impact of epilepsy leads some to believe their epilepsy is genetic.
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Affiliation(s)
- Diana C. Garofalo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Shawn T. Sorge
- G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Clinical Psychology, Long Island University, Brooklyn, New York
| | - Dale C. Hesdorffer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Melodie R. Winawer
- G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jo C. Phelan
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Wendy K. Chung
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ruth Ottman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York
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22
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Sajobi TT, Amoozegar F, Wang M, Wiebe N, Fiest KM, Patten SB, Jette N. Global assessment of migraine severity measure: preliminary evidence of construct validity. BMC Neurol 2019; 19:53. [PMID: 30947702 PMCID: PMC6448190 DOI: 10.1186/s12883-019-1284-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background In persons with migraine, severity of migraine is an important determinant of several health outcomes (e.g., patient quality of life and health care resource utilization). This study investigated how migraine patients rate the severity of their disease and how these ratings correlate with their socio-demographic, clinical, and psycho-social characteristics. Methods This is a cohort of 263 adult migraine patients consecutively enrolled in the Neurological Disease and Depression Study (NEEDs). We obtained a broad range of clinical and patient-reported measures (e.g., patients’ ratings of migraine severity using the Global Assessment of Migraine Severity (GAMS), and migraine-related disability, as measured by the Migraine Disability Scale (MIDAS)). Depression was measured using the 9-item Patient Health Questionnaire (PHQ-9) and the 14-item Hospital Anxiety and Depression Scale (HADS). Median regression analysis was used to examine the predictors of patient ratings of migraine severity. Results The mean age for the patients was 42.5 years (SD = 13.2). While 209 (79.4%) patients were females, 177 (67.4%) participants reported “moderately severe” to “extremely severe” migraine on the GAMS, and 100 (31.6%) patients had chronic migraine. Patients’ report of severity on the GAMS was strongly correlated with patients’ ratings of MIDAS global severity question, overall MIDAS score, migraine type, PHQ-9 score, and frequency of migraine attacks. Mediation analyses revealed that MIDAS mediated the effect of depression on patient ratings of migraine severity, accounting for about 32% of the total effect of depression. Overall, migraine subtype, frequency of migraine, employment status, depression, and migraine-related disability were statistically significant predictors of patient-ratings of migraine severity. Conclusions This study highlights the impact of clinical and psychosocial determinants of patient-ratings of migraine severity. GAMS is a brief and valid tool that can be used to assess migraine severity in busy clinical settings.
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Affiliation(s)
- Tolulope T Sajobi
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Cumming School of Medicine 3280 Hospital Drive NW Calgary, Calgary, Alberta, T2N 4Z6, Canada.
| | - Farnaz Amoozegar
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Meng Wang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Natalie Wiebe
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Cumming School of Medicine 3280 Hospital Drive NW Calgary, Calgary, Alberta, T2N 4Z6, Canada
| | - Kirsten M Fiest
- Department of Critical Medicine, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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23
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Tan M, Boston R, Cook MJ, D'Souza WJ. Risk factors for injury in a community-treated cohort of patients with epilepsy in Australia. Epilepsia 2019; 60:518-526. [PMID: 30720862 DOI: 10.1111/epi.14659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There remains a paucity of knowledge regarding specific epilepsy-related risk factors for accidents and injuries in people with epilepsy. Injury studies in people with epilepsy are overrepresented, with tertiary based populations that are prone to bias from severe disease. This study aims to assess the contribution of epilepsy-related risk factors to injuries in a community-based cohort. METHODS We performed a retrospective nested case-control study on patients recruited into the Tasmanian Epilepsy Register (TER) from July 1, 2001 to June 30, 2002. The TER is a community-based cohort of patients with epilepsy in Tasmania, Australia, recruited from the national prescription database and interviewed for epilepsy diagnosis, injuries, and risk factors using validated questionnaires with diagnosis made by an epilepsy specialist. The primary outcome measures were lifetime and recent 12-month injury. Multivariate logistic regression with multiple imputation modeling responder nondisclosure was performed, adjusting for age, gender, region, socioeconomic status, seizure frequency, and epilepsy duration. RESULTS A total of 819 patients with epilepsy were included in this study. Ten percent of patients experienced an injury in the preceding year. Before adjusting for seizure frequency, any seizure over the past 12 months was associated with recent injury (adjusted odds ratio [OR] = 7.90, 95% confidence interval [CI] = 4.17-14.96). Impaired awareness, cluster seizures, sleep-only seizures, and convulsive seizure were characteristics found to significantly influence injuries irrespective of seizure frequency. Although a warning appeared initially protective for recent injuries (OR = 0.39, 95% CI = 0.22-0.69), this was entirely explained by seizure frequency, with the effect becoming nonsignificant. SIGNIFICANCE Likely due to their unpredictable nature, seizures expose patients with epilepsy to a high risk of life-threatening injury. These findings emphasize the importance of seizure freedom for maximizing the safety of patients with epilepsy.
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Affiliation(s)
- Michael Tan
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ray Boston
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Mark J Cook
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
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24
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Crooks RE, Bell M, Patten SB, Wiebe S, Holroyd-Leduc J, Bulloch AG, Macrodimitris S, Mackie A, Sauro KM, Federico P, Jetté N. Mind the gap: Exploring information gaps for the development of an online resource hub for epilepsy and depression. Epilepsy Behav 2017; 70:18-23. [PMID: 28407525 DOI: 10.1016/j.yebeh.2017.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/27/2017] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Depression is common in epilepsy, and is often under-detected and under-treated. The motivation to create a depression eHub for persons with epilepsy is to connect them to the best available online resources to effectively manage their depression. The study sought to: 1) identify facilitators and barriers to accessing resources related to management of epilepsy and/or depression and 2) discuss gaps in available resources (free and in the public domain) and 3) identify suggestions for future content. METHODS Semi-structured interviews were conducted with ten patients with epilepsy and a history of depression. Using inductive analysis, two team members engaged in a process of textual open-coding utilizing a conventional content analysis approach whereby content was conceptually clustered based on the research questions. A phenomenological framework was applied to describe the phenomenon of online health resource access and utilization from the perspective of people with epilepsy. RESULTS Facilitators to the use of online resources included information credibility, thoughtful organization, and accessibility of resources. Barriers included difficulties finding and piecing together information from many different sites. Patients reported difficulty having the motivation to seek out resources while depressed, which was compounded by feelings of stigma, social isolation, and lack of control. Gaps in resources included a lack of information about living with epilepsy day-to-day and resources for family and friends. Suggested content included information to raise awareness about epilepsy and depression; questionnaires to screen for symptoms of depression; stories of other patients with epilepsy and depression via video or moderated forums; current research and news; local community resources; and tools and strategies to manage depression in epilepsy. CONCLUSIONS There is a gap in accessible resources for patients with epilepsy and depression as well as barriers that include epilepsy-related restrictions, depression-related impairments, lack of awareness, and stigmatization. These results should be used to guide the development of e-Health resources for patients with epilepsy.
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Affiliation(s)
- Rachel E Crooks
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Meaghan Bell
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Scott B Patten
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; The Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Jayna Holroyd-Leduc
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Andrew G Bulloch
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; The Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Sophia Macrodimitris
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Aaron Mackie
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Khara M Sauro
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Paolo Federico
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Nathalie Jetté
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
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25
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Josephson CB, Patten SB, Bulloch A, Williams JVA, Lavorato D, Fiest KM, Secco M, Jette N. The impact of seizures on epilepsy outcomes: A national, community-based survey. Epilepsia 2017; 58:764-771. [PMID: 28345152 DOI: 10.1111/epi.13723] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to examine the impact of seizures on persons living with epilepsy in a national, community-based setting. METHODS The data source was the Survey of Living with Neurological Conditions in Canada (SLNCC), a cohort derived from a national population-based survey of noninstitutionalized persons aged 15 or more years. Participants had to be on a seizure drug or to have had a seizure in the past 5 years to meet the definition of active epilepsy. The respondents were further stratified by seizure status: the seizure group experienced ≥1 seizure in the past 5 years versus the no seizure group who were seizure-free in the past ≥5 years regardless of medication status. Weighted overall and stratified prevalence estimates and odds ratios were used to estimate associations. RESULTS The SLNCC included 713 persons with epilepsy with a mean age of 45.4 (standard deviation 18.0) years. Fewer people in the seizure group (42.7%) reported being much better than a year ago versus those in the no seizure group (70.1%). Of those with seizures, 32.1% (95% confidence interval [95% CI] 18.8-45.3) had symptoms suggestive of major depression (as per the Patient Health Questionnaire-9) compared to 7.7% (95% CI 3.4-11.9) of those without seizures. Driving, educational, and work opportunities were also significantly limited, whereas stigma was significantly greater in those with seizures. SIGNIFICANCE This community-based study emphasizes the need for seizure freedom to improve clinical and psychosocial outcomes in persons with epilepsy. Seizure freedom has an important influence on overall health, as those with at least one seizure over the prior 5 years had an increased risk of mood disorders, worse quality of life, and faced significantly more stigma.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Bulloch
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Jeanne V A Williams
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dina Lavorato
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Critical Care, University of Calgary, Calgary, Alberta, Canada
| | - Mary Secco
- Canadian Epilepsy Alliance, London, Ontario, Canada.,Neurological Health Charities Canada, London, Ontario, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
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