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Zhang SH, Wang JH, Liu HY, Zhang YX, Lin YL, Wu BY. Effects of intensive psychological intervention on treatment compliance, psychological status, and quality of life of patients with epilepsy. World J Psychiatry 2024; 14:670-677. [PMID: 38808083 PMCID: PMC11129149 DOI: 10.5498/wjp.v14.i5.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Epilepsy is a nervous system disease characterized by recurrent attacks, a long disease course, and an unfavorable prognosis. It is associated with an enduring therapeutic process, and finding a cure has been difficult. Patients with epilepsy are predisposed to adverse moods, such as resistance, anxiety, nervousness, and anxiety, which compromise treatment compliance and overall efficacy. AIM To explored the influence of intensive psychological intervention on treatment compliance, psychological status, and quality of life (QOL) of patients with epilepsy. METHODS The clinical data of 105 patients with epilepsy admitted between December 2019 and July 2023 were retrospectively analyzed, including those of 50 patients who underwent routine intervention (control group) and 55 who underwent intensive psychological intervention (research group). Treatment compliance, psychological status based on the Self-Rating Anxiety Scale (SAS) and Depression Scale Self-Rating Depression Scale (SDS) scores, hope level assessed using the Herth Hope Scale (HHS), psychological resilience evaluated using the Psychological Resilience Scale, and QOL determined using the QOL in Epilepsy-31 Inventory (QOLIE-31) were comparatively analyzed. RESULTS Treatment compliance in the research group was 85.5%, which is significantly better than the 68.0% of the control group. No notable intergroup differences in preinterventional SAS and SDS scores were identified (P > 0.05); however, after the intervention, the SAS and SDS scores decreased significantly in the two groups, especially in the research group (P < 0.05). The two groups also exhibited no significant differences in preinterventional HHS, Connor-Davidson Resilience Scale (CD-RISC), and QOLIE-31 scores (P > 0.05). After 6 months of intervention, the research group showed evidently higher HHS, CD-RISC, tenacity, optimism, strength, and QOLIE-31 scores (P < 0.05). CONCLUSION Intensive psychological intervention enhances treatment compliance, psychological status, and QOL of patients with epilepsy.
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Affiliation(s)
- Su-Hua Zhang
- Department of Neurology, Quanzhou First Hospital, Quanzhou 362000, Fujian Province, China
| | - Jie-Hua Wang
- Department of Neurology, Quanzhou First Hospital, Quanzhou 362000, Fujian Province, China
| | - Hong-Yu Liu
- Department of Neurology, Quanzhou First Hospital, Quanzhou 362000, Fujian Province, China
| | - Yue-Xia Zhang
- Department of Neurology, Quanzhou First Hospital, Quanzhou 362000, Fujian Province, China
| | - Ya-Ling Lin
- Department of Neurology, Quanzhou First Hospital, Quanzhou 362000, Fujian Province, China
| | - Bi-Yu Wu
- Department of Nursing, Quanzhou First Hospital, Quanzhou 362000, Fujian Province, China
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Tinsae T, Shumet S, Takelle GM, Rtbey G, Fentahun S, Getinet W. Perceived and self-stigma in people with epilepsy in East Africa: Systematic review and meta-analysis. Seizure 2024; 117:261-270. [PMID: 38547570 DOI: 10.1016/j.seizure.2024.03.003] [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: 12/16/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND People with stigmatizing conditions associated with epilepsy encounter many difficulties in their daily lives and are more likely to have low self-esteem, low levels of hope, internalize negative attitudes, decrease adherence to treatment, and experience unemployment. The purpose of this study was to quantify the extent of perceived stigma and self-stigma among people with epilepsy. METHODOLOGY This systematic review and meta-analysis followed the Preferred Reporting Item Review and Meta-analysis (PRISMA) guideline. PubMed, PsycINFO, Web of Science, Cochrane Library, Google Scholar, and HINARI were major search databases. The included literature reports the prevalence of perceived stigma and self-stigma among people with epilepsy in East Africa. The quality of each study was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). Data were extracted using a Microsoft Excel spreadsheet, and data analysis was performed using STATA version 11. The pooled prevalence of perceived stigma and self-stigma was determined using a random effect model. Heterogeneity between studies was checked using the I2 statistical test. Publication bias was checked using Egger's statistical test and funnel plot. RESULTS The pooled prevalence of perceived stigma and self-stigma in people with epilepsy was 43.9 % with a 95 % CI (29.2, 58.7) and 41.2 % with a 95 % CI (12.1, 70.3), respectively. Based on the country, sub-group analysis revealed that the prevalence of perceived stigma among people with epilepsy shows a notable difference between the countries. In Ethiopia, the prevalence was 51.8 % with a 95 % CI of 29.8 to 73.8; in Uganda, 39.4 % with a 95 % CI of 27.1 to 51.3; in Tanzania, 27.4 % with a 95 % CI of 27.9 to 36.9; and in Kenya, 33.2 % with a 95 % CI of 28.2 to 38.2. CONCLUSION Roughly 30 % of people with epilepsy experience self-stigma, while approximately 44 % of people with epilepsy experience perceived stigma. As a result, the relevant authorities ought to focus on reducing the prevalence of stigma among people who have epilepsy.
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Affiliation(s)
- Techilo Tinsae
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Gondar, Ethiopia.
| | - Shegaye Shumet
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Gondar, Ethiopia
| | - Gidey Rtbey
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Gondar, Ethiopia
| | - Setegn Fentahun
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Gondar, Ethiopia
| | - Wondale Getinet
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Gondar, Ethiopia
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Seid J, Gebrehiwot B, Andualem F, Kassaye A, Mohammed J, Akele M. Factors associated with stress-related symptoms among people with epilepsy in Ethiopia, a cross-sectional study. Front Neurol 2023; 14:1218448. [PMID: 37583951 PMCID: PMC10425181 DOI: 10.3389/fneur.2023.1218448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Stress is a common psychological problem present in people with epilepsy and has a serious impact on the health-related satisfaction of people with epilepsy and their cohabiters. This study aimed to assess the magnitude and related factors of stress. Methods A hospital-based cross-sectional study was carried out among 301 systematically chosen people with epilepsy. The seven stress-related items of the Depression, Anxiety, and Stress -21 questionnaire was used to measure stress. Data were entered using Epi Info and analyzed by SPSS version 25. Predictors with a p-value < 0.20 in the bivariate logistic regression were transferred into the multivariate model. A p-value of less than 0.05 was viewed as statistically significant. Result The prevalence of stress symptoms in this study was 23.9%. Daily labor occupational status with Adjusted Odds ratio [(AOR) = 0.042, 95% CI: 0.004, 0.469], onset of illness at the age of 18 years and above (AOR = 0.188, 95% CI: 0.046, 0.771), perceived stigma (AOR = 3.320, 95% CI: 1.345, 8.200), the presence of anxiety symptoms (AOR = 8.275, 95% CI: 3.345, 20.471), and belief that the condition is untreatable (AOR = 6.360, 95% CI: 1.647, 24.562) were significantly associated factors. Conclusion The occurrence of stress was high, and it reinforced that there is a requisite for the identification and handling of stress-related symptoms among people with epilepsy.
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Affiliation(s)
- Jemal Seid
- Department of Psychiatric Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Birhane Gebrehiwot
- Department of Psychiatric Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatric Nursing, College of Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Abenet Kassaye
- Department of Psychiatric Nursing, College of Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Jemal Mohammed
- Department of Medicine, Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| | - Mulugeta Akele
- Department of Psychiatry, College of Medicine and Health Science, Mizan-Tepi University, Mizan, Ethiopia
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Lee SA, Im K, Choi EJ. Felt stigma may potentiate the relationship between perceived stress and depressive symptoms in persons with epilepsy. Epilepsy Behav 2022; 134:108765. [PMID: 35908417 DOI: 10.1016/j.yebeh.2022.108765] [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: 02/10/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study assessed the strengths of association among perceived stress, felt stigma, and depression in adults with epilepsy, and evaluated whether felt stigma altered the association between perceived stress and depression. METHODS This multicenter, cross-sectional study included adults with epilepsy. Depression was assessed using the Beck Depression Inventory (BDI), and perceived stress was evaluated using the 10-item Perceived Stress Scale. Felt stigma was determined using the three-item Stigma Scale for Epilepsy, with individuals categorized as positive for felt stigma if they answered "yes" to at least one of these items. A hierarchical linear regression analysis and an analysis of covariance with interaction terms were performed. RESULTS The 316 adults with epilepsy included 171 men and 145 women; of these, 109 (34.5%) reported felt stigma. A hierarchical linear regression analysis showed that perceived stress was the most important correlate of depressive symptoms, followed by felt stigma, being unemployed, recurrence of generalized or focal to bilateral tonic-clonic seizures, and being married. The model explained 54.0% of the variance of BDI scores. Significant interactions between felt stigma and perceived stress on BDI scores was identified in both crude and adjusted models (p < 0.05 each). Specifically, in an adjusted model, BDI scores were more strongly associated with perceived stress in persons with (p < 0.001, partial eta2 = 0.225) than without (p < 0.001, partial eta2 = 0.205) felt stigma. CONCLUSIONS Perceived stress was the most significant correlate of depressive symptoms in adults with epilepsy, followed by felt stigma. The interaction between perceived stress and felt stigma on depressive symptoms was significant. These findings may help in developing cognitive behavioral therapy for stigma and stress management in persons with epilepsy.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Kayeong Im
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Choi
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Gargiulo ÁJ, Sarudiansky M, Videla A, Lombardi N, Korman GP, Oddo S, D Alessio L. Perceived stress, resilience, and stress coping in patients with drug resistant epilepsy and functional dissociative seizures. Seizure 2022; 101:141-148. [PMID: 36027685 DOI: 10.1016/j.seizure.2022.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Depression and anxiety are psychiatric disorders related to chronic stress, commonly found in patients with drug-resistant epilepsy (DRE) and functional dissociative seizures (FDS). The present study compares the levels of perceived stress, resilience, and the styles of stress coping among patients with DRE (n=60), FDS (n=28), and controls (n=31). METHODS We performed a cross-sectional study. All patients underwent Video Electroencephalography to confirm the diagnosis and completed the psychiatric assessment (SCID I and II of DSM IV) supported by several instruments validated in Spanish. RESULTS FDS scored higher in perceived stress (p = 0.004) with lower levels of resilience compared to controls (p = 0.01). Stress coping subscales show higher scores in negative self-focus and hostility in patients with FDS compared to controls (p=0.003). Similarly, DRE patients scored higher in perceived stress (p = 0.001), and presented lower levels of resilience (p = 0.004) with higher levels of hostility compared to controls (p=0.02). However, no significant differences were found between FDS and DRE on stress coping variables. Anxiety scores and depression rates were higher in the FDS group compared to DRE (p=0.008) and higher in DRE compared to controls (p<0.05). A positive correlation between depression and perceived stress was found (r = 0.6, p=0.0001). CONCLUSIONS Our results delineate a more detailed picture of the psychological profile of this population, emphasizing the importance of stress factors in patients with FDS and DRE. Combined intervention strategies which enhance stress coping may be appropriate to direct treatment and psychotherapy.
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Affiliation(s)
- Ángel Jm Gargiulo
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias)-CONICET, Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS), Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía.
| | - Mercedes Sarudiansky
- Universidad de Buenos Aires (UBA), Facultad de Psicología- CONICET, Buenos Aires, Argentina
| | - Alejandro Videla
- Jefe de departamento de neumonología del Hospital Universitario Austral (HUA), Buenos Aires, Argentina
| | - Nicolás Lombardi
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía
| | - Guido P Korman
- Universidad de Buenos Aires (UBA), Facultad de Psicología- CONICET, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía
| | - Silvia Oddo
- Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS), Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía
| | - Luciana D Alessio
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias)-CONICET, Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía
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Whitney S, Bedard C, Mielke J, Browne DT, Ferro MA. Do subjective and objective measures of stress agree in a clinical sample of youth and their parents? COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 11:100155. [PMID: 35864882 PMCID: PMC9294048 DOI: 10.1016/j.cpnec.2022.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022] Open
Abstract
This study explored agreement and potential relationships among perceived stress (self-reported using the Perceived Stress Scale), hair cortisol concentration (HCC), and mental disorders in a clinical sample of youth and their parents. Data were collected from a cross-sectional sample of 48 youth (38 females; mean age = 15.6 years) with a mental disorder and 72 parents (65 females; mean age = 45.49 years). Agreement was assessed using Bland-Altman plots and intraclass correlation coefficients. Multiple regression was used to model the association between covariates and HCC and perceived stress for youth and parents. Agreement between perceived stress and HCC was low for both youth and parents (ICC = 0.15 to 0.31). Among youth, lower income (β = 0.24) and parent psychopathology (β = 0.42) were associated with higher HCC. Female sex (β = 0.42) and higher parent psychopathology (β = 0.28) were associated with higher perceived stress, whereas chronic physical illness was associated with lower perceived stress (β = −0.24). Among parents, female sex (β = −0.21) was associated with lower HCC and family functioning (β = 0.46) was associated with higher perceived stress. In youth, higher HCC was associated with generalized anxiety (OR = 1.14) and higher perceived stress was associated with major depressive episode (OR = 1.33), generalized anxiety (OR = 1.10), and separation anxiety (OR = 1.14). Among parents, higher HCC was associated with depression (β = 0.27) and perceived stress was associated with depression (β = 0.53) and anxiety (β = 0.45). This exploratory study shows that agreement between psychological and physiological stress is low in a clinical sample of youth and their parents. Sociodemographic and psychosocial factors, and mental health, are differentially associated with psychological and physiological stress. Agreement between perceived stress and hair cortisol is low for youth and parents. Sex, physical illness, and parent psychopathology are associated with youth stress. Sex and family functioning are associated with stress among parents. Hair cortisol and perceived stress are differentially associated with mental illness.
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Affiliation(s)
- Sydney Whitney
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L3G1, Canada
| | - Chloe Bedard
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L3G1, Canada
- Corresponding author.
| | - John Mielke
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L3G1, Canada
| | - Dillon T. Browne
- Department of Psychology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L3G1, Canada
| | - Mark A. Ferro
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L3G1, Canada
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Psychometric properties of a Turkish version of the quality of life in childhood epilepsy questionnaire. J Pediatr Nurs 2022; 62:91-97. [PMID: 34625303 DOI: 10.1016/j.pedn.2021.09.009] [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: 03/24/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Epilepsy is a neurological disease that requires long-term treatment and monitoring and causes significant restrictions in physical, emotional, intellectual, and social life that negatively affect the quality of life of the individual. This study aimed to test the validity and reliability of the Quality of Life in Childhood Epilepsy Questionnaire in Turkey. METHODS The study was conducted on 421 parents using a descriptive correlational method. The data of the study were collected using a Descriptive Information Form and the Quality of Life in Childhood Epilepsy Questionnaire. Data analysis and evaluation were performed using factor analysis, Cronbach's alpha, and item-total score correlation. FINDINGS The scale consists of 16 items and four sub-dimensions. The four sub-dimensions recorded a variance of 87.83%. Cronbach's alpha coefficient of the Turkish version of the scale was 0.96. The two-month test-retest reliability evaluated with intra-class correlation was 0.85. Confirmatory factor analysis indicated, the model fit index results were recorded as follows: 0.93 as the Goodness-of-Fit Index; comparative fit index, 0.98 and non-normed fit index (NNFI), 0.97. CONCLUSIONS The study determined that the Turkish version of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16) is a valid and reliable measurement tool when used to measure quality of life for Turkish children with epilepsy. PRACTICE IMPLICATIONS It is recommended that the health-related quality of life should be evaluated to assess the treatment of children with epilepsy and to intervene early in potential risk factors associated with the disease management process. All healthcare professionals can use this scale in interventional studies aiming at evaluating or improving the quality of life of children with epilepsy.
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Medel-Matus JS, Orozco-Suárez S, Escalante RG. Factors not considered in the study of drug-resistant epilepsy: Psychiatric comorbidities, age and gender. Epilepsia Open 2021; 7 Suppl 1:S81-S93. [PMID: 34967149 PMCID: PMC9340311 DOI: 10.1002/epi4.12576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022] Open
Abstract
In basic research and clinical practice, the control of seizures has been the most important goal but it should not be the only one. There are factors that remain poorly understood in the study of refractory epilepsy such as the age and gender of patients and the presence of psychiatric comorbidities. It is known that in patients with drug-resistant epilepsy (DRE), the comorbidities contribute to the deterioration of the quality of life, increase the severity, and worsen the prognosis of epilepsy. Some studies have demonstrated that patients diagnosed with a co-occurrence of epilepsy and psychiatric disorders are more likely to present refractory seizures and the probability of seizure remission after pharmacotherapy is reduced. The evidence of this association suggests the presence of shared pathogenic mechanisms that may include endocrine disorders, neuroinflammatory processes, disturbances of neurotransmitters and mechanisms triggered by stress. Additionally, significant demographic, clinical and electrographic differences have been observed between women and men with epilepsy. Epilepsy affects the female gender in a greater proportion, although there are no studies that report whether refractoriness affects more females. The reasons behind these sex differences are unclear; however, it is likely that sex hormones and sex brain differences related to chromosomal genes play an important role. On the other hand, it has been shown in industrialized countries that prevalence of DRE is higher in the elderly when compared to youngsters. Conversely, this phenomenon is not observed in developing regions, where more cases are found in children and young adults. The correct identification and management of these factors is crucial in order to improve the quality of life of the patients.
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Affiliation(s)
- Jesús Servando Medel-Matus
- Department of Pediatrics, Neurology Division, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, U.S.A
| | - Sandra Orozco-Suárez
- Unit of Medical Research in Neurological Diseases, Specialty Hospital "Dr, Bernardo Sepúlveda", National Medical Center S.XXI, Mexico City, Mexico
| | - Ruby G Escalante
- Department of Pediatrics, Neurology Division, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, U.S.A
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Patient Health Questionnaire (PHQ-9): A depression screening tool for people with epilepsy in Vietnam. Epilepsy Behav 2021; 125:108446. [PMID: 34839244 DOI: 10.1016/j.yebeh.2021.108446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is a common mental disorder in people with epilepsy. Depression has a negative impact on medical and surgical treatment of epilepsy thus affecting the quality of life. Despite its high prevalence, depression has been under-recognized and treated improperly. It may also lead to missed work, increased healthcare system utilization, and higher direct medical costs. OBJECTIVES This study aimed to evaluate the accuracy of the Vietnamese Patient Health Questionnaire (PHQ-9) as a screening tool for depression in people with epilepsy. METHODS This cross-sectional study was conducted prospectively at epilepsy clinic at Nguyen Tri Phuong hospital, Ho Chi Minh City, Viet Nam from December 2019 to March 2020. A total of 91 adult people with epilepsy were recruited. After completing the Vietnamese PHQ-9 questionnaires, each participant was interviewed in a structured clinical interview for DSM-5 (SCID-5) to establish a diagnosis of major depressive disorder. The diagnostic accuracy of the PHQ-9 was assessed using diagnostic efficiency statistics compared with the gold standard structured interview. RESULTS The prevalence of major depression in this sample was 25.3%. The areas under receiver operating characteristic (ROC) curve index of PHQ-9 had an estimated value of 0.91. The PHQ-9 at a cutoff point of 8 had the great overall balance of sensitivity (87.0%) and specificity (82.4%). At the cutoff point of 10, PHQ-9 had a higher specificity of 94.1%, but a lower sensitivity of 78.0%. CONCLUSIONS The Vietnamese version PHQ-9 is an efficient and valid screening tool for depression in people with epilepsy in clinic settings.
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10
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Vacca M, Fernandes M, Spanetta M, Placidi F, Izzi F, Lombardo C, Mercuri NB, Liguori C. Depressive symptoms in patients with epilepsy and clinically associated features in a single tertiary center. Neurol Sci 2021; 43:1965-1974. [PMID: 34528181 PMCID: PMC8860796 DOI: 10.1007/s10072-021-05589-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Although depressive symptoms are the most common psychiatric comorbidity in epilepsy, they remain underestimated and untreated in a large proportion of patients. The purpose of this study was to evaluate depression severity and related clinical features in people with epilepsy using a well-reliable self-report index of mood, the Beck Depression Inventory-II (BDI-II). One-hundred seventeen adult patients with epilepsy were recruited from a tertiary epilepsy center and completed the BDI-II. A single-item analysis of the 21 questions of the BDI-II was computed and differences between women and men in each depressive symptom were evaluated. Correlation and regression analyses were used to identify clinical features associated with the severity of depression. Results showed gender differences in some items, with women reporting overall higher depression severity than men. The most common symptoms regarded domains of sleeping patterns, tiredness, and loss of energy. Regression evidence suggested that being female, having an epilepsy duration < 10 years, as well as being treated with psychotropic drugs and reporting generalized seizure, were associated with higher depression severity. Despite its cross-sectional nature, this study reinforces the importance of investigating and possibly treating depressive symptoms in adult patients with epilepsy, since they negatively impact well-being, daytime activities, and sleep. Further studies identifying pharmacological and non-pharmacological treatments for depression in epilepsy need to be planned.
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Affiliation(s)
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Spanetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Placidi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Francesca Izzi
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | | | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.,IRCSS Santa Lucia Foudantion, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. .,Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.
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11
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Kuroda N, Fujimoto A. Considering temporality in causal relationship between seizure worsening and psychological stress in patients with epilepsy during the COVID-19 pandemic: A systematic review. Epilepsy Behav 2021; 122:108184. [PMID: 34252833 PMCID: PMC9761278 DOI: 10.1016/j.yebeh.2021.108184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate whether published studies that identified a causal relationship between psychological stress and seizure worsening in patients with epilepsy during the coronavirus disease 2019 (COVID-19) pandemic considered the temporality of Hill's criteria. METHOD A systematic review approach was used to comprehensively search MEDLINE, CENTRAL, EMBASE, and ClinicalTrials.gov databases for relevant studies. Studies that reported an association between psychological stress and seizure worsening in patients with epilepsy during the COVID-19 pandemic were included accordingly. The quality of assessments in each study was evaluated and an assessment for considering temporality in the causal relationship between the two events in each study was carried out. RESULTS Seventeen studies were included in the analysis. Most (14/17) were cross-sectional studies and only four out of these 17 studies (23.5%) considered temporality in the causality. Further, these four studies did not consider temporality in the study design, they only described it as a limitation. CONCLUSION We found that many articles reported a causal relationship between psychological stress and seizure worsening without considering temporality. As both researchers and readers, we need to consider temporality when interpreting the causal relationship between increased psychological stress and seizure worsening in patients with epilepsy during the COVID-19 pandemic.
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Affiliation(s)
- Naoto Kuroda
- Department of Pediatrics, Wayne State University, Detroit, MI, USA; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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12
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Şenadım S, Alpaydın Baslo S, Uygun E, Erdoğan M, Balçik ZE, Tekin B, Ataklı D. The strategies for coping with stress of epilepsy patients. Neurol Sci 2021; 42:4265-4270. [PMID: 34142262 DOI: 10.1007/s10072-021-05372-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aims to compare the styles of coping with stress between patients with epilepsy and healthy individuals and to examine the effects of clinical features on methods of coping with stress. METHODS The study enrolled 120 patients diagnosed with epilepsy. Forty healthy individuals were included as control group. Sociodemographic and clinical characteristics of the patients were recorded. The patients and controls completed the Coping Strategies with Stress Inventory (COPE), which comprises 60 items distributed into 15 scales. The COPE scores of the patients and controls were compared. RESULTS Comparing the COPE scores of the patients and controls, the substance use score was higher in the controls. In terms of gender, seeking instrumental social support, active coping, seeking emotional social support, acceptance, and emotion-focused total coping scores were higher in women among patients. In terms of marital status, the positive reinterpretation and growth score of single patients was significantly higher than that of married patients. In patients with a history of febrile convulsions, the active coping, seeking emotional social support, and denial scores were higher. In terms of treatment, for the patients receiving polytherapy, the suppression of competing activities, focus on and venting of emotions, and dysfunctional total coping scores were higher than in patients receiving monotherapy. CONCLUSION Epilepsy and stress are intertwined conditions. Epilepsy patients, confronted with stress, avoided using alcohol and substances compared to healthy individuals. There were differences among epilepsy patients according to gender, marital status, febrile convulsion history, number of medications, and approaches to coping with stress.
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Affiliation(s)
- Songül Şenadım
- Department of Neurology, Faculty of Medicine, Istanbul Aydın University, Istanbul, Turkey
| | - Sezin Alpaydın Baslo
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | | | - Mücahid Erdoğan
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Ezgi Balçik
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | - Betül Tekin
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey.
| | - Dilek Ataklı
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
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13
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Sarahian N, Mohammadi MT, Darabi S, Faghihi N. Fenofibrate protects the neurovascular unit and ameliorates plasma corticosterone levels in pentylenetetrazole-induced kindling seizure in mice. Brain Res 2021; 1758:147343. [PMID: 33556377 DOI: 10.1016/j.brainres.2021.147343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/03/2021] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
Epileptic seizures are the most common neurological diseases that change the function of neurovascular unit at molecular levels accompanied by activation of a wide variety of neurodegenerative cascades. Based on the pleiotropic functions of peroxisome proliferator-activated receptor-alpha (PPARα), the current study evaluated the neuroprotective effects of fenofibrate (an effective PPARα agonist) on the brain injuries induced by pentylenetetrazole (PTZ)-induced kindling seizure. Adult male NMRI mice were randomly assigned into four groups (n = 14) as follows; control, untreated kindled mice (PTZ) and two fenofibrate-treated kindled groups. Repeated intraperitoneal injections of PTZ (45 mg/kg) were used to develop kindling seizure every 48 h for 21 days. Treated mice were administered orally fenofibrate at doses of 30 and 50 mg/kg/day during the study. Plasma corticosterone and brain levels of brain-derived neurotrophic factor (BDNF), malondialdehyde (MDA) and mRNA transcription of p53, as well as blood-brain barrier (BBB) permeability, were determined at termination of the study. Fenofibrate considerably improved seizure latency and anxiety-like behaviors in treated kindled mice. Fenofibrate at doses of 30 and 50 mg/kg significantly (P < 0.001) decreased plasma corticosterone (56.88 ± 0.80 and 54.81 ± 0.29 ng/mL, respectively) compared to PTZ group (74.96 ± 1.60 ng/mL). It also significantly (P < 0.05) decreased BDNF levels in both treatment groups (8.13 ± 0.14 and 8.74 ± 0.09 ng/mL, respectively) compared to PTZ group (9.68 ± 0.20 ng/mL). Fenofibrate particularly at higher dose significantly (P < 0.01) decreased MDA content and mRNA expression levels of p53 in treated kindled mice by 67% and 28%, respectively, compared to PTZ group. Similarly, 50 mg/kg fenofibrate significantly (P < 0.05) decreased Evans blue extravasation into brain in treated kindled mice (8.72 ± 0.96 µg/g) compared to PTZ group (15.31 ± 2.18 µg/g). Our results revealed the anticonvulsive and neuroprotective effects of fenofibrate in PTZ-induced kindling seizure in mice. Fenofibrate also improved the neurovascular functions at molecular levels in kindling seizure that might be associated with ameliorating the seizure behaviors.
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Affiliation(s)
- Nahid Sarahian
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Mohammadi
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran; Department of Physiology and Medical Physics, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran; Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Shamsi Darabi
- Department of Physiology, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Nastaran Faghihi
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
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14
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Zhong R, Chen Q, Li M, Li N, Chu C, Li J, Zhang X, Lin W. A cross-sectional study on the association of serum uric acid levels with depressive and anxiety symptoms in people with epilepsy. BMC Psychiatry 2021; 21:17. [PMID: 33413258 PMCID: PMC7791969 DOI: 10.1186/s12888-020-03019-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND High serum uric acid (SUA) levels may provide protection against depression and anxiety through its defensive role in oxidative damage. The aim of this study was to test the hypothesis of the independent associations of lower SUA levels with depressive and anxiety symptoms among patients with epilepsy (PWE). METHODS A cross-sectional study was performed among 320 PWE aged ≥18 years old in Northeast China. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E; Chinese version) and the Generalized Anxiety Disorder-7 scale (GAD-7; Chinese version) were used as screening tools for depressive and anxiety symptoms for PWE. Serum uric acid levels were measured. The associations of SUA levels with depressive and anxiety symptoms were assessed by using binary logistic regression models, with adjustment for the related risk factors (P< 0.05). RESULTS Lower SUA tertiles were significantly associated with higher C-NDDI-E and GAD-7 scores compared with the higher two tertiles (p=0.001, and p= 0.002). Patients with depressive symptoms exhibited significantly lower SUA levels compared to those without depressive symptoms (p< 0.001). SUA levels of patients with anxiety symptoms were significantly lower than those of patients without anxiety symptoms (p< 0.001). The first and second SUA tertiles were associated with depressive symptoms, with the third tertile group as the reference group, after adjusting for confounders (first tertile: OR = 4.694, 95% CI = 1.643~ 13.413, P = 0.004; second tertile: OR = 3.440, 95% CI = 1.278~9.256, P = 0.014). However, The first and second SUA tertiles were not associated with the risk of anxiety symptoms compared with the third tertile in the adjusted logistic regression model (First tertile: OR = 1.556, 95% CI = 0.699~3.464, P = 0.279; second tertile: OR = 1.265, 95% CI = 0.607~2.635, P = 0.530). CONCLUSION We found that lower SUA levels were independently associated with depressive symptoms but not with anxiety symptoms among PWE. Further well-designed prospective cohort studies are required to determine the causality of the associations and to further clarify the mechanisms of SUA in depressive symptoms.
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Affiliation(s)
- Rui Zhong
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Qingling Chen
- grid.265021.20000 0000 9792 1228Department of Hepatology, Tianjin Medical University, Tianjin Second People’s Hospital, Tianjin, China
| | - Mengmeng Li
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Nan Li
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Chaojia Chu
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Jing Li
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Xinyue Zhang
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, China.
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15
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Ayar D, Bektas M, Ünalp A, Edizer S, Yalçintuğ FM, Güdeloğlu E. The association between seizure self-efficacy of children with epilepsy and the perceived stigma. Epilepsy Behav 2020; 110:107141. [PMID: 32450533 DOI: 10.1016/j.yebeh.2020.107141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
This study used a descriptive, correlational, and cross-sectional research design to evaluate the effect of seizure self-efficacy of children with epilepsy on their perceived stigma of seizure. The study was conducted with 303 children with epilepsy. The data of the study were collected using "the Seizure Self-Efficacy Scale for Children" and "the Scale for Perceived Stigma in Children with Epilepsy". The mean age of the children included in the study was 12.65 ± 2.37. The correlation between seizure self-efficacy of the children and their perceived seizure stigma was examined; a strong, significant, and negative correlation was found. It is recommended that the awareness of all health professionals should be increased in approaching children with epilepsy and that self-efficacy and stigma should be addressed.
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Affiliation(s)
- Dijle Ayar
- Dokuz Eylul University, Faculty of Nursing, Pediatric Nursing Department, Izmir, Turkey.
| | - Murat Bektas
- Dokuz Eylul University, Faculty of Nursing, Pediatric Nursing Department, Izmir, Turkey
| | - Aycan Ünalp
- Dr. Behcet Uz Childrens Diseases and Pediatric Surgery Training and Research Hospital, Pediatric Neurologist, Izmir, Turkey
| | - Selvinaz Edizer
- Dr. Behcet Uz Childrens Diseases and Pediatric Surgery Training and Research Hospital, Pediatric Neurologist, Izmir, Turkey
| | | | - Elif Güdeloğlu
- Dr. Behcet Uz Childrens Diseases and Pediatric Surgery Training and Research Hospital, Pediatric Palliative, Izmir, Turkey
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16
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Huang S, Wu C, Jia Y, Li G, Zhu Z, Lu K, Yang Y, Wang F, Zhu S. COVID-19 outbreak: The impact of stress on seizures in patients with epilepsy. Epilepsia 2020; 61:1884-1893. [PMID: 32761900 PMCID: PMC7436883 DOI: 10.1111/epi.16635] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/24/2020] [Accepted: 07/10/2020] [Indexed: 01/17/2023]
Abstract
Objective Stress is a known trigger for seizures in patients with epilepsy (PWE). However, the association between stress and seizures has not been thoroughly investigated. In December 2019, an outbreak of coronavirus disease (COVID‐19) occurred in Wuhan, Hubei province, China, causing tremendous collateral stress. This study was designed to evaluate the influence of the COVID‐19 outbreak on seizures in PWE in the most severely affected area, Wuhan, and its surrounding cities. Methods In this single‐center, cross‐sectional study, PWE were surveyed via online questionnaires between February 23 and March 5, 2020. Collected data included demographic information, epilepsy‐related characteristics (seizure type, frequency, antiepileptic drugs [AEDs], and medication management), direct and perceived threat of COVID‐19, and changes in seizures during the outbreak. Psychological comorbidities were evaluated by the Patient Health Questionnaire–9, Generalized Anxiety Disorder–7 items, and Insomnia Severity Index (ISI). Multivariate logistic regression was used to identify precipitants for seizure exacerbation. Results We received 362 completed questionnaires after excluding 12 duplicates (response rate = 63.51%). A total of 31 (8.56%) patients had increased seizures during the outbreak. Exposure history to COVID‐19 (P = .001), uncontrolled seizure after AED therapy (P = .020), seizure frequency of two or more times per month before the outbreak (P = .005), change of AED regimen during the outbreak (AED reduction, withdrawal, replacement, skipping altogether; P = .002), and worry about the adverse effect of the outbreak on overall seizure‐related issues (severity = moderate to critical; P = .038) were risk factors for increased seizures. Significance A minority of PWE experienced seizure exacerbation during the outbreak of COVID‐19. Stress, uncontrolled seizures, and inappropriate change in AED regimen were associated with increased seizures. Based on these findings, stress might be an independent precipitant for triggering seizures in some PWE.
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Affiliation(s)
- Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunmei Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchao Jia
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Lu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuyan Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Furong Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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17
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Blum RA, Tomlinson AR, Jetté N, Kwon CS, Easton A, Yeshokumar AK. Assessment of long-term psychosocial outcomes in anti-NMDA receptor encephalitis. Epilepsy Behav 2020; 108:107088. [PMID: 32375094 DOI: 10.1016/j.yebeh.2020.107088] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/18/2020] [Accepted: 03/30/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to assess long-term psychosocial outcomes of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (anti-NMDARE). METHODS Adolescents and adults with self-reported anti-NMDARE were invited to complete an online survey distributed by relevant patient organizations. Demographic and clinical information was collected, including the diagnoses initially given for anti-NMDARE symptoms and posthospital care received. Patient-Reported Outcomes Measurement Information System (PROMIS) Psychosocial Impact Illness - Negative short form (Negative PSII) was administered to assess psychosocial outcome of anti-NMDARE. Associations between clinical factors and psychosocial outcomes were evaluated. RESULTS Sixty-one individuals with anti-NMDARE age 15 years and above participated. Mean age was 33.7 years (standard deviation [SD]: 12.8), and participants were predominantly female (90.2%, n = 55). Mean T-score on PROMIS Negative PSII was 60.7, >1 SD higher (worse psychosocial function) than that of the provided normalized sample enriched for chronic illness (50, SD: 10). Initial misdiagnosis of anti-NMDARE symptoms was associated with decreased odds (odds ratio [OR]: 0.11, p < 0.05), and follow-up with a psychiatrist after hospitalization with increased odds (OR: 8.46, p < 0.05), of return to work/school after illness. Younger age of symptom onset and presence of ongoing neuropsychiatric issues were predictive of worse Negative PSII scores (p < 0.05). CONCLUSION Individuals with anti-NMDARE demonstrate poor psychosocial outcomes, yet there are no current standards for long-term assessment or management of such symptoms in this population. These findings highlight the need for use of more comprehensive outcome measures that include assessment of psychosocial function and the importance of developing interventions that address this domain for individuals with anti-NMDARE.
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Affiliation(s)
- Raia A Blum
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA.
| | - Amanda R Tomlinson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA.
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA.
| | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA.
| | - Ava Easton
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool L69 7BE, UK; The Encephalitis Society, 32 Castlegate, Malton YO17 7DT, North Yorkshire, UK.
| | - Anusha K Yeshokumar
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA; Autoimmune Encephalitis Alliance, 920 Urban Avenue, Durham, NC 27701, USA.
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18
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Yates K, Lång U, DeVylder J, Clarke M, McNicholas F, Cannon M, Oh H, Kelleher I. Prevalence and psychopathologic significance of hallucinations in individuals with a history of seizures. Epilepsia 2020; 61:1464-1471. [PMID: 32524599 DOI: 10.1111/epi.16570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A relationship between seizure activity and hallucinations is well established. The psychopathologic significance of hallucinations in individuals with seizures, however, is unclear. In this study, we assessed the prevalence of auditory and visual hallucinations in individuals who reported a seizure history and investigated their relationship with a number of mental disorders, suicidal ideation, and suicide attempts. METHODS Data were from the "Adult Psychiatric Morbidity Survey," a population-based cross-sectional survey. Auditory and visual hallucinations were assessed using the Psychosis Screening Questionnaire. Mental health disorders were assessed using the Clinical Interview Schedule. Logistic regressions assessed relationships between hallucinatory experiences and mental disorders, suicidal ideation, and suicide attempts. RESULTS A total of 14 812 adults (58% female; mean [standard error of the mean; SEM] age 51.8 [0.15]) completed the study; 1.39% reported having ever had seizures (54% female), and 8% of individuals with a seizure history reported hallucinatory experiences (odds ratio [OR] 2.05, 95% confidence interval [CI] 1.24-3.38). Individuals with seizures had an increased odds of having any mental disorder (OR 2.34, 95% CI 1.73-3.16), suicidal ideation (OR 2.38, 95% CI 1.77-3.20), and suicide attempt (OR 4.15, 95% CI 2.91-5.92). Compared to individuals with seizures who did not report hallucinatory experiences, individuals with seizures who reported hallucinatory experiences had an increased odds of any mental disorder (OR 3.47, 95% CI 1.14-10.56), suicidal ideation (OR 2.58, 95% CI 0.87-7.63), and suicide attempt (OR 4.61, 95% CI 1.56-13.65). Overall, more than half of individuals with a seizure history who reported hallucinatory experiences had at least one suicide attempt. Adjusting for psychopathology severity did not account for the relationship between hallucinatory experiences and suicide attempts. SIGNIFICANCE Hallucinatory experiences in individuals with seizures are markers of high risk for mental health disorders and suicidal behavior. There is a particularly strong relationship between hallucinations and suicide attempts in individuals with seizures. Clinicians working with individuals with seizures should routinely ask about hallucinatory experiences.
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Affiliation(s)
- Kathryn Yates
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ulla Lång
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Department of Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Fiona McNicholas
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.,Lucena Clinic, St. John of God Community Mental Health Services, Dublin, Ireland.,Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Lucena Clinic, St. John of God Community Mental Health Services, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
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19
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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.
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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.
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20
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Garcia DDS, Polydoro MS, Alvim MKM, Ishikawa A, Moreira JCV, Nogueira MH, Zanão TA, de Campos BM, Betting LEGG, Cendes F, Yasuda CL. Anxiety and depression symptoms disrupt resting state connectivity in patients with genetic generalized epilepsies. Epilepsia 2019; 60:679-688. [PMID: 30854641 DOI: 10.1111/epi.14687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To analyze the lifetime trajectories in genetic generalized epilepsies (GGEs) and investigate the impact of symptoms of anxiety and depression on resting state functional connectivity (FC). METHODS Seventy-four GGE patients were classified according to the pharmacological response as seizure-free (12 patients), pharmacoresistant (PhR; 14 patients), and fluctuating (FL; 48 patients). Fifty-four subjects completed both the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and 38 also underwent 3-T resting state functional magnetic resonance imaging. These 38 patients were subdivided into a positive group (13 patients with concurrent symptoms of depression and anxiety) and a negative group (21 asymptomatic patients and four with mild anxiety or depression symptoms). For FC analysis of resting state networks, we matched 38 healthy asymptomatic volunteers and used the UF2C toolbox running on MATLAB2017/SPM12. RESULTS The PhR group presented shorter duration of epilepsy (P = 0.016) and follow-up (P < 0.001) compared to the FL group. The PhR group showed higher levels (median = 20) on the BAI and BDI. Myoclonic seizures were the most difficult to control, as 50% of subjects persisted with them at last appointment, compared to generalized tonic-clonic seizures and absence seizures (<40%). Patients with concurrent anxiety and depression symptoms were 7.7 times more likely to exhibit pharmacoresistant seizures, although an increase of 1 year of epilepsy duration was associated with a decrease in the odds of presenting pharmacoresistance by a factor of 0.9. Overall, FC was altered between default mode network (DMN) and visuospatial/dorsal attention. However, only the positive group displayed abnormal FC between DMN and left executive control network, and between salience and visuospatial/dorsal attention. SIGNIFICANCE Our findings may help clinicians to have a better understanding of GGE clinical course and increase attention to the potential relationship of psychopathologies and brain connectivity.
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Affiliation(s)
| | | | - Marina Kutsodontis Machado Alvim
- Laboratory of Neuroimaging, University of Campinas, Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil
| | - Akari Ishikawa
- Laboratory of Neuroimaging, University of Campinas, Campinas, Brazil
| | | | | | | | | | | | - Fernando Cendes
- Laboratory of Neuroimaging, University of Campinas, Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil
| | - Clarissa L Yasuda
- Laboratory of Neuroimaging, University of Campinas, Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil
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21
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Oppenheimer J, Leviton A, Chiujdea M, Antonetty A, Ojo OW, Garcia S, Weas S, Fleegler EW, Chan E, Loddenkemper T. Caring electronically for young outpatients who have epilepsy. Epilepsy Behav 2018; 87:226-232. [PMID: 30197227 DOI: 10.1016/j.yebeh.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to review electronic tools that might improve the delivery of epilepsy care, reduce medical care costs, and empower families to improve self-management capability. METHOD We reviewed the epilepsy-specific literature about self-management, electronic patient-reported or provider-reported outcomes, on-going remote surveillance, and alerting/warning systems. CONCLUSIONS The improved care delivery system that we envision includes self-management, electronic patient (or provider)-reported outcomes, on-going remote surveillance, and alerting/warning systems. This system and variants have the potential to reduce seizure burden through improved management, keep children out of the emergency department and hospital, and even reduce the number of outpatient visits.
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Affiliation(s)
- Julia Oppenheimer
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alan Leviton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Madeline Chiujdea
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Annalee Antonetty
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Oluwafemi William Ojo
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie Garcia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Weas
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric W Fleegler
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eugenia Chan
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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22
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Kim M, Kim YS, Kim DH, Yang TW, Kwon OY. Major depressive disorder in epilepsy clinics: A meta-analysis. Epilepsy Behav 2018; 84:56-69. [PMID: 29753295 DOI: 10.1016/j.yebeh.2018.04.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Although depression is a frequent psychiatric comorbidity in people with epilepsy (PWE), its prevalence has been underestimated. Comorbid depression has negative impacts on treatment outcomes and quality of life (QOL). It also causes various problems in PWE, such as fatigue, irritability, and suicidality. This meta-analysis was performed to estimate the frequency of major depression disorder (MDD) in clinics managing PWE. METHODS We searched MEDLINE, EMBASE, Cochrane Library, Web of Science, and SCOPUS to identify studies. Hospital-based studies and original research presenting information regarding prevalence of MDD, determined using a gold standard diagnostic tool in adult PWE, were considered for inclusion. The prevalence of depression was examined by meta-analysis. In addition, subgroup analysis was performed based on the continent where the selected studies were conducted, the strictness of selection criteria, and gender. Strict selection criteria were defined as any mention of the use of exclusion criteria. RESULTS A total of 6607 studies were identified by searching the five databases outlined above. After screening and rescreening, 35 studies were included in the meta-analysis. The total number of PWE was 5434. In the test for heterogeneity of the studies, I2 was 68.014, and the Cochran Q value was 106.296 (p < 0.01). As a pooled estimate, the point prevalence of MDD in PWE was 21.9% with a 95% confidence interval (CI) of 20.8-23.0 in a fixed effects model. In subgroup analyses, continent partly explained the heterogeneity among the selected studies, but the strictness of selection criteria did not. The prevalence of MDD was higher in females than in males (26.4% vs. 16.7%, respectively) with an odds ratio (OR) of 1.805 (95% CI: 1.443-2.258; p < 0.01). CONCLUSIONS The point prevalence of MDD is estimated at 21.9% among PWE in epilepsy clinics and is higher in females than in males. Based on this relatively high prevalence in PWE, measures are required to identify and resolve MDD. In addition, the female predominance of MDD among PWE indicates a need to pay greater attention to females. Such efforts may reduce the impact of depression in PWE and improve their QOL.
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Affiliation(s)
- Minjung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Young-Soo Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Do-Hyung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Tae-Won Yang
- Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Oh-Young Kwon
- Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
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23
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Can a collaborative healthcare network improve the care of people with epilepsy? Epilepsy Behav 2018; 82:189-193. [PMID: 29573986 DOI: 10.1016/j.yebeh.2018.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/31/2023]
Abstract
New opportunities are now available to improve care in ways not possible previously. Information contained in electronic medical records can now be shared without identifying patients. With network collaboration, large numbers of medical records can be searched to identify patients most like the one whose complex medical situation challenges the physician. The clinical effectiveness of different treatment strategies can be assessed rapidly to help the clinician decide on the best treatment for this patient. Other capabilities from different components of the network can prompt the recognition of what is the best available option and encourage the sharing of information about programs and electronic tools. Difficulties related to privacy, harmonization, integration, and costs are expected, but these are currently being addressed successfully by groups of organizations led by those who recognize the benefits.
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24
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Lang JD, Taylor DC, Kasper BS. Stress, seizures, and epilepsy: Patient narratives. Epilepsy Behav 2018; 80:163-172. [PMID: 29414547 DOI: 10.1016/j.yebeh.2018.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 01/25/2023]
Abstract
In epilepsy, individual seizures can be triggered by a variety of external and internal stimuli. One of the most common trigger factors reported by patients is stress. However prevalent, stress-related triggering of episodes seems underappreciated in epilepsy for various reasons, and its misinterpretation often leads to other diagnoses, e.g., psychogenic nonepileptic seizures (PNES) or normal reactions. This article illustrates the significant role of stress as a seizure-provoking factor by referring to nine patient narratives. From this perspective, it appears that there are characteristic patterns of stress triggering, e.g., stress-induced sleep disruption, forms of acute stress, or relaxation after stress. Sometimes seizures are mistaken as symptoms of stress. Patient narratives contain interesting clues relating reports about stress and seizure histories to different epilepsy syndromes as well as nonepileptic episodes in a way that can strongly support the diagnostic process. A narrative approach is particularly valuable in this context. Therefore, accounts of stress triggering in seizures and other episodes should not be neglected, but rather taken seriously, sought and actively explored as a crucial element when taking clinical histories in patients with episodic attacks.
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Affiliation(s)
- Johannes D Lang
- Epilepsy Center, Department of Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - David C Taylor
- The Institute of Child Health, Department of Neurology, University College London, London, WC1N 1EH, UK
| | - Burkhard S Kasper
- Epilepsy Center, Department of Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
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25
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Gunn BG, Baram TZ. Stress and Seizures: Space, Time and Hippocampal Circuits. Trends Neurosci 2017; 40:667-679. [PMID: 28916130 DOI: 10.1016/j.tins.2017.08.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/11/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
Stress is a major trigger of seizures in people with epilepsy. Exposure to stress results in the release of several stress mediators throughout the brain, including the hippocampus, a region sensitive to stress and prone to seizures. Stress mediators interact with their respective receptors to produce distinct effects on the excitability of hippocampal neurons and networks. Crucially, these stress mediators and their actions exhibit unique spatiotemporal profiles, generating a complex combinatorial output with time- and space-dependent effects on hippocampal network excitability and seizure generation.
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Affiliation(s)
- B G Gunn
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - T Z Baram
- Department of Pediatrics, University of California, Irvine, CA, USA; Department of Anatomy & Neurobiology, University of California, Irvine, CA, USA; Department of Neurology, University of California, Irvine, CA, USA.
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26
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Moon HJ, Seo JG, Park SP. Perceived stress in patients with migraine: a case-control study. J Headache Pain 2017; 18:73. [PMID: 28733942 PMCID: PMC5520838 DOI: 10.1186/s10194-017-0780-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/04/2017] [Indexed: 01/03/2023] Open
Abstract
Background Perceived stress is the most common trigger for migraine. The objective of this study was to examine the clinical significance of perceived stress in migraine patients. Methods This is a case-control study. Consecutive migraine patients who visited a tertiary care hospital were enrolled for this study. They completed self-reported questionnaires including Perceived Stress Scale (PSS), 12-item Allodynia Symptom Checklist (ASC-12), Migraine Disability Assessment Scale (MIDAS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Migraine-Specific Quality of Life Questionnaire (MSQ). Degree of perceived stress in migraine patients was measured and compared to that in healthy controls. Predictors for perceived stress and their impact on quality of life (QOL) of migraine patients were also determined. Results A total of 227 migraine patients were eligible for this study, including 103 (45.4%) who had chronic migraine (CM). Mean PSS score was significantly (p < 0.05) higher in CM patients than that in controls after adjusting for education, depression, and anxiety. Although several factors were associated with PSS score, major predictors for PSS were GAD-7 score (β = 0.358, p < 0.001), PHQ-9 score (β = 0.304, p < 0.001), ISI score (β = 0.154, p = 0.005), and CM (β = −0.104, p = 0.027). There was an inverse relationship between PSS scores and three-dimensional scores of MSQ (p < 0.001). Conclusions Chronic migraine is a critical factor for perceived stress. Perceived stress affects QOL of migraine patients.
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Affiliation(s)
- Hye-Jin Moon
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Sung-Pa Park
- Department of Neurology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea.
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27
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Nogueira MH, Yasuda CL, Coan AC, Kanner AM, Cendes F. Concurrent mood and anxiety disorders are associated with pharmacoresistant seizures in patients with MTLE. Epilepsia 2017; 58:1268-1276. [PMID: 28555776 DOI: 10.1111/epi.13781] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate whether mood disorders (MD) and anxiety disorders (AD) are associated with seizure control in patients with mesial temporal lobe epilepsy (MTLE). We compared patients without any current psychiatric disorder, patients with current MD and/or AD, patients with subsyndromic depression episodes (SSDE) and anxiety episodes (SSAE), and patients with family psychiatric history. METHODS In a cross-sectional study, we included 144 consecutive patients with MTLE (82 pharmacoresistant and 62 treatment-responsive patients). Every patient underwent a psychiatric evaluation including the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) Axis I (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and Interictal Dysphoric Disorder Inventory (IDDI). Patients were divided into four groups: PsychNeg (G1, n = 61), current SSDE and SSAE (G2, n = 26), Current MD or AD (G3, n = 25), and current mixed MD/AD (G4, n = 32). RESULTS Among patients with pharmacoresistant MTLE, 68.3% (56/82) experienced symptoms of depression and/or anxiety (G2, G3, and G4) (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.41-5.53, p < 0.01). Patients with mixed MD/AD (G4, n = 24/32) were more likely to have pharmacoresistant MTLE (OR 4.04, 95% CI 1.57-10.42, p < 0.01) than psychiatric asymptomatic patients (G1, n = 26/61), and their seizure frequency was significantly higher (p < 0.01). Positive family psychiatric history was more frequent in pharmacoresistant patients (n = 27/82, OR 2.28, 95% CI 1.02-5.05, p = 0.04). Finally, 31.6% of patients with MD and or AD were not receiving psychiatric treatment. SIGNIFICANCE Identification of comorbid MD/AD and of family psychiatric history is of the essence in patients with MTLE, as they appear to be associated with worse seizure control.
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Affiliation(s)
- Mateus H Nogueira
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Clarissa L Yasuda
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil.,Department of Neurology, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Ana C Coan
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil.,Department of Neurology, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Andres M Kanner
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Fernando Cendes
- Laboratory of Neuroimaging, University of Campinas, UNICAMP, Campinas, SP, Brazil.,Department of Neurology, University of Campinas, UNICAMP, Campinas, SP, Brazil
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28
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Shi Y, Wang S, Ying J, Zhang M, Liu P, Zhang H, Sun J. Correlates of perceived stigma for people living with epilepsy: A meta-analysis. Epilepsy Behav 2017; 70:198-203. [PMID: 28431368 DOI: 10.1016/j.yebeh.2017.02.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/12/2017] [Accepted: 02/12/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Epilepsy, one of the most common, serious chronic neurological diseases, is accompanied by different levels of perceived stigma that affects people in almost all age groups. This stigma can negatively impact the physical and mental health of people living with epilepsy (PLWE). Good knowledge of perceived stigma for PLWE is important. In this study, we conducted a meta-analysis to identify the correlates of perceived stigma for PLWE. METHODS Studies on factors associated with perceived stigma for PLWE, including sociodemographic, psychosocial, and disease-related variables, were searched in PubMed, PsychINFO, EMBASE, and Web of Science. RESULTS Nineteen variables (k>1) were included in the meta-analysis. For sociodemographic characteristics, findings revealed that the significant weighted mean correlation (R) for "residence" and "poor financial status" were 0.177 and 0.286, respectively. For disease-related characteristics, all variables of significance, including "seizure severity," "seizure frequency," "number of medicines," and "adverse event" (R ranging from 0.190 to 0.362), were positively correlated with perceived stigma. For psychosocial characteristics, "depression" and "anxiety" with R values of 0.414 and 0.369 were significantly associated with perceived stigma. In addition, "social support," "quality of life (QOLIE-31,89)," "knowledge," and "attitude," with R values ranging from -0.444 to -0.200 indicating negative correlation with perceived stigma. CONCLUSION The current meta-analysis evaluated the correlates of perceived stigma for PLWE. Results can serve as a basis for policymakers and healthcare professionals for formulating health promotion and prevention strategies.
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Affiliation(s)
- Ying Shi
- School of Nursing, Jilin University, Changchun, China
| | - Shouqi Wang
- School of Nursing, Jilin University, Changchun, China
| | - Jie Ying
- School of Nursing, Jilin University, Changchun, China
| | - Meiling Zhang
- School of Nursing, Jilin University, Changchun, China
| | - Pengcheng Liu
- School of Nursing, Jilin University, Changchun, China
| | | | - Jiao Sun
- School of Nursing, Jilin University, Changchun, China.
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29
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McKee HR, Privitera MD. Stress as a seizure precipitant: Identification, associated factors, and treatment options. Seizure 2016; 44:21-26. [PMID: 28063791 DOI: 10.1016/j.seizure.2016.12.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022] Open
Abstract
Stress is a common and important seizure precipitant reported by epilepsy patients. Studies to date have used different methodologies to identify relationships between epilepsy and stress. Several studies have identified anxiety, depression, and childhood trauma as being more common in patients with epilepsy who report stress as a seizure precipitant compared to patients with epilepsy who did not identify stress as a seizure precipitant. In one survey study it was found that a majority of patients with stress-triggered seizures had used some type of stress reduction method on their own and, of those who tried this, an even larger majority felt that these methods improved their seizures. Additionally, small to moderate sized prospective trials, including randomized clinical trials, using general stress reduction methods have shown promise in improving outcomes in patients with epilepsy, but results on seizure frequency have been inconsistent. Based on these studies, we recommend that when clinicians encounter patients who report stress as a seizure precipitant, these patients should be screened for a treatable mood disorder. Furthermore, although seizure reduction with stress reduction methods has not been proven in a randomized controlled trial, other important endpoints like quality of life were improved. Therefore, recommending stress reduction methods to patients with epilepsy appears to be a reasonable low risk adjunctive to standard treatments. The current review highlights the need for future research to help further clarify biological mechanisms of the stress-seizure relationship and emphasizes the need for larger randomized controlled trials to help develop evidence based treatment recommendations for our epilepsy patients.
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Affiliation(s)
- Heather R McKee
- Department of Neurology, Epilepsy Division, UC Gardner Neuroscience Institute, University of Cincinnati Medical Center (0525), 260 Stetson St., Suite 2300, Cincinnati, OH 45267-0525, USA.
| | - Michael D Privitera
- Department of Neurology, Epilepsy Division, UC Gardner Neuroscience Institute, University of Cincinnati Medical Center (0525), 260 Stetson St., Suite 2300, Cincinnati, OH 45267-0525, USA.
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