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Cerulli Irelli E, Borioni MS, Morano A, Mazzeo A, Moro P, Orlando B, Salamone EM, Giordano L, Petrungaro A, Toccaceli Blasi M, Giallonardo AT, Canevelli M, Di Bonaventura C. Frailty as a comprehensive health measure beyond seizure control in patients with epilepsy: A cross-sectional study. Epilepsia 2024; 65:1658-1667. [PMID: 38536086 DOI: 10.1111/epi.17964] [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: 12/28/2023] [Revised: 02/12/2024] [Accepted: 03/11/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Due to the high clinical heterogeneity of epilepsy, there is a critical need for novel metrics aimed at capturing its biological and phenotypic complexity. Frailty is increasingly recognized in various medical disciplines as a useful construct to understand differences in susceptibility to adverse outcomes. Here, we develop a frailty index (FI) for patients with epilepsy (PwE) and explore its association with demographic and clinical features. METHODS In this cross-sectional study, we consecutively enrolled 153 PwE from an outpatient epilepsy clinic. Participants were assessed for various health deficits to calculate the FI. Associations between FI and demographic/clinical features, antiseizure medications (ASMs), and patient-reported outcomes were analyzed using general linear models and Spearman correlation. RESULTS The median age at the time of study visit was 47 years (interquartile range = 33-60), and 89 (58.2%) patients were females. Multiple linear regression revealed that the developed 33-item FI showed an independent association with age, female sex, higher body mass index, family history of epilepsy, intellectual disability, and the number of ASMs used. A robust analysis of covariance showed higher FI levels in patients using cytochrome P450 3A4-inducer ASMs. We found a moderate positive correlation between FI and psychological distress, lower quality of life, and physical frailty, measured by the Hospital Anxiety and Depression Scale, Quality of Life in Epilepsy Inventory-10, and handgrip strength, respectively. Finally, a weak association was observed between higher FI scores and an increased number of epileptic falls. SIGNIFICANCE This study highlights the significance of frailty as a comprehensive health measure in epilepsy. It suggests that frailty in this specific population is not only a manifestation of aging but is inherently linked to epilepsy and treatment-related factors. Future research is warranted to validate and refine the FI in diverse epilepsy populations and investigate its impact on specific adverse outcomes in longitudinal studies.
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Affiliation(s)
| | - Maria S Borioni
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Adolfo Mazzeo
- Institute of Research and Medical Care Neuromed, Pozzilli, Italy
| | | | - Biagio Orlando
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Luca Giordano
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Alessio Petrungaro
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- Neurorehabilitation Unit, IRCCS Santa Maria Nascente, Don Carlo Gnocchi Foundation, Milan, Italy
| | | | | | - Marco Canevelli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- Policlinico Umberto I, Rome, Italy
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Yeni K, Tulek Z, Cavusoglu A, Dunya CP, Erden SO, Bostan NS, Bebek N, Baykan B. Caregiver burden and its predictors in adult epilepsy patients. Epilepsy Behav 2024; 153:109685. [PMID: 38368790 DOI: 10.1016/j.yebeh.2024.109685] [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: 11/24/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate caregiver burden and factors associated with caregiver burden in caregivers of adults with epilepsy. MATERIALS AND METHODS This descriptive cross-sectional study was conducted with 107 patients with epilepsy and 107 their primary caregivers. Personal information form including sociodemographic data and Zarit Caregiver Burden Inventory (ZBI), were used for caregivers, and patient information form, Montreal Cognitive Assessment Scale (MoCA), Hospital Anxiety and Depression Scale (HADS), Epilepsy Quality of Life Scale (QoLIE-31) and Stigma Scale were used for patients. RESULTS Caregiver burden was found to be related to gender (p = 0.047), marital status (p = 0.008), income (p = 0.003), education level (p = 0.05) age at onset of epilepsy (p = 0.025) and type of therapy (p = 0.005). The scale scores for cognitive functions (p < 0.001), stigma (p < 0.001), anxiety (p = 0.001), depression (p = 0.005), and quality of life (p < 0.001) of the patient showed significant correlations with caregiver burden. In addition, caregiver burden was found to correlate with some caregiver characteristics such as caregivers' age (p = 0.041), gender (p < 0.001), education (p < 0.001), income (p = 0.001) and relationship with the patient (p = 0.016). Time spent on caregiving per day was also positively correlated with caregiving burden (p < 0.001). In regression analysis, the gender of the caregiver, the gender of the patient, the stigma level of patient, and the type of treatment were found to be predictors of care burden (p < 0.05, R2 = 0.61). CONCLUSION It was found that two-thirds of the families of patients with epilepsy experienced varying degrees of caregiver burden. In addition, it was determined that caregiver burden was associated with sociodemographic and numerous psychosocial factors of the patient as well as the caregiver. It is important that both the caregiver and the patient being cared for are closely evaluated in interventions to reduce the caregiver burden in patients with epilepsy.
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Affiliation(s)
- Kubra Yeni
- Ondokuz Mayis University, Faculty of Health Sciences, Samsun, Turkey.
| | - Zeliha Tulek
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Istanbul, Turkey
| | - Aysel Cavusoglu
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey
| | | | - Sevda Ozturk Erden
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Nur Sena Bostan
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Nerses Bebek
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey; Istanbul University, Center for Research in Epilepsy, Istanbul, Turkey
| | - Betul Baykan
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey; Istanbul University, Center for Research in Epilepsy, Istanbul, Turkey
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Balbinot P, Pellicano R, Testino G. Burden of caregiving of alcohol related liver disease patients: a possible role of training and caregiver groups frequency. Proposal of a method, preliminary results. Minerva Gastroenterol (Torino) 2023; 69:486-493. [PMID: 36255285 DOI: 10.23736/s2724-5985.22.03288-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The patient with alcohol related liver disease (ALD) is an extremely complex patient who can be affected by various problems: alcohol use disorders (AUDs) (intoxication or withdrawal syndrome), psychopathological manifestations, hepatic encephalopathy (HE), family and social discomfort. Burden of caregiving for this type of patient is particularly severe. For this reason we propose our own working model. METHODS Thirty-one informal caregivers (ICs) of patients with ALD (28 females; mean age: 51±11) recruited in the period September-November 2021 followed prospectively were evaluated retrospectively. Those who completed all the steps (initial information/ training meeting), participation in support groups for caregivers and participation in self-help groups for AUD (club of alcoholics in treatment, anonymous family members, other realities) were selected (31/71: 43%). ICs underwent Zarit Burden Interview and a semi-structured interview. RESULTS From the semi-structured interview, emotional, organizational, but also constructive reflections emerge. Zarit Score (ZS) was found to be light or nil in the 13% (4/31), moderate in the 22.5% (7/31), severe in the 32% (10/31) and very serious in the 32% (10/31). The parameters that most influenced initial ZS are the presence of HE and primitive psychiatric comorbidity (PC). By dividing the caregivers into two groups (40) odds ratio is 2.4231 (95% CI: 0.4059-14.4637) in the presence of HE and odds ratio is 5.3846 (95% CI: 0.5666 to 51.1738) in the presence of PC. After the frequency to the caregiver groups (CGs) (at least 4) the ZS is significantly decreased (49.9±18 vs. 34±11; t=4.1966; P<0.0001) and this regardless of the presence of HE, PC or active alcohol consumption. CONCLUSIONS While waiting to increase the number of cases and to submit it to a more in-depth verification, we suggest to other health organizations to use and verify this organizational/ relational method for primary ICs, in an attempt to optimize the health and social health activity in a complex medical sector (ALD) in constant growth.
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria, Polyclinic San Martino Hospital, Genoa, Italy
- Centro Studi Mutual-self-help, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
| | | | - Gianni Testino
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria, Polyclinic San Martino Hospital, Genoa, Italy
- Centro Studi Mutual-self-help, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
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Okiah L, Olowo S, Iramiot SJ, Nekaka R, Ssenyonga LVN. Lived experiences of caregivers of persons with epilepsy attending an epilepsy clinic at a tertiary hospital, eastern Uganda: A phenomenological approach. PLoS One 2023; 18:e0274373. [PMID: 37463142 PMCID: PMC10353802 DOI: 10.1371/journal.pone.0274373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Epilepsy has been found to affect caregivers' quality of life, lifestyle, psychological health, social well-being, and working time. Caregivers in Uganda as in the rest of the world are important in assisting a person with epilepsy in complying with medical directions and are actively involved in communicating with healthcare professionals. Little is known about the lived experiences of caregivers of persons afflicted with epilepsy in Uganda. The purpose of this study was to determine the lived experiences of caregivers of persons with epilepsy attending the epilepsy clinic at Mbale regional referral hospital, eastern Uganda. METHODS AND MATERIALS The caregivers' lived experiences were elicited directly from them and their health workers who work with them in the care of the patients. Forty participants which consisted of 30 caregivers and 10 key informant health workers were selected for the study through purposive sampling. Face-to-face in-depth interviews with an unstructured interview guide were conducted to gather participants' information. The principal investigator conceptualized the interview guide, the guide was then reviewed by co-investigators, and revised and approved as the final data collection instrument after an extensive and comprehensive literature review. The interview guide comprised two sections; the first section comprised the questions that elicited the participants' social-demographic information. The second section comprised questions that explored caregivers' experiences of persons afflicted with epilepsy. Notations were taken and a digital recorder was used purposely for audio recordings. All interviews lasted for an hour and were audio-recorded with the participant's consent. An inductive thematic analysis was employed and adopted to identify the patterns emerging from the texts. RESULTS The caregivers majorly perceived epilepsy as a burden. Four main themes were revealed from the analysis and these are: psychological burdens which included, worries about the future of the patient, being looked down upon; social burdens which entailed, affected public relations, feelings of stigma; an economic burden which included interference with the source of income, affected productivity at work; and physical burdens which included, Feelings of uneasiness and disrupted sleep among others. CONCLUSION The caregivers majorly perceived epilepsy as a serious burden. This burden can be psychological, social, economic, and physical. Therefore, services and plans targeting patients with epilepsy need to consider the burden that caregivers encounter to comprehensively manage epilepsy.
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Affiliation(s)
- Lindah Okiah
- Department of Nursing, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Samuel Olowo
- Department of Nursing, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Stanely J. Iramiot
- Department of Microbiology and Immunology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Rebecca Nekaka
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Lydia V. N. Ssenyonga
- Department of Nursing, Busitema University Faculty of Health Sciences, Mbale, Uganda
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Büyükbayram Z, Aksoy M, Yılmaz R. Difficult lives: A descriptive and relational study on the coping with stress and care burden of caregivers of patients with epilepsy. Epilepsy Behav 2023; 145:109297. [PMID: 37336137 DOI: 10.1016/j.yebeh.2023.109297] [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: 04/06/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
AIM This study was conducted to examine the relationship between coping with stress status and the burden of care of the caregivers of patients with epilepsy. MATERIALS AND METHODS This descriptive correlational study was carried out with a total of 230 voluntary caregivers of patients with epilepsy who visited the neurology clinics and outpatient clinics of a training and research hospital in the southeastern part of Turkiye between March 2022 and February 2023. Study data were collected through the Personal Information Form, the Zarit Caregiver Burden Assessment and the Ways of Coping Scale. Descriptive statistics and multiple regression analysis were used for the evaluation of the data. FINDINGS While the mean score of the caregivers from the Zarit Caregiver Burden Assessment was 41.20 ± 12.44, they had mean scores of 12.12 ± 3.25, 8.93 ± 1.93, 12.24 ± 3.61, 8.77 ± 3.17, and 7.89 ± 1.95, respectively, from the self-confident approach, optimistic approach, helpless approach, submissive approach, and social support-seeking approach sub-dimensions. In the study, a moderate positive statistically significant relationship was found between the caregivers' burden of care and the mean scores of the helpless and submissive approach sub-dimensions(p < 0.05). CONCLUSION The caregivers' burden of care and coping with stress were at moderate levels. The helpless approach, which is one of the ineffective methods of coping with stress, was found to be higher. The helpless and submissive approaches were found to increase in this study as the caregivers' burden of care increased. IMPLICATIONS The use of effective coping skills to reduce the level of personal burden of care would improve the caregiver's physical health and psychological well-being.
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Affiliation(s)
- Zeliha Büyükbayram
- Siirt University, Faculty of Health Sciences, Department of Internal Medicine Nursing, Siirt, Turkey.
| | - Meyreme Aksoy
- Siirt University, Faculty of Health Sciences, Department of Nursing Fundamentals, Siirt, Turkey.
| | - Rıdvan Yılmaz
- Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
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Şahin Yıldız Y, Dülger H, Kasapoğlu ES. Web-based training for future healthcare professionals who will care for elderly individuals with epilepsy receiving home care: A quasi-experimental study. Epilepsy Behav 2023; 145:109285. [PMID: 37295314 DOI: 10.1016/j.yebeh.2023.109285] [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: 02/21/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The need for home care for elderly people with epilepsy is increasing. This study aims to determine the knowledge and attitudes of the students and examine the effect of the web-based epilepsy education program given to health students who will care for elderly individuals with epilepsy receiving home care. METHODS This quasi-experimental study with a control group pre-post-test research design was conducted with 112 students (intervention: 32/control: 80) studying in the Department of Health Care Services (home care, elderly care) in Turkey. The sociodemographic information form, Epilepsy Knowledge Scale, and Epilepsy Attitude Scale were used for data collection. Web-based training in three two-hour sessions focusing on the medical and social aspects of epilepsy was applied to the intervention group in this study. RESULTS It was found that the epilepsy knowledge scale score of the intervention group increased from 5.56 (±4.96) to 13.15 (±2.56), and the epilepsy attitude scale score increased from 54.12 (±9.73) to 62.31 (±7.07) after the training. After the training; there was a significant difference in all items except the 5th item in the knowledge scale and the 14th item in the attitude scale (p < 0.05). SIGNIFICANCE In the study; it has been found that the web-based epilepsy education program provided increases students' knowledge and develops positive attitudes. This study will provide evidence for strategies to be developed to improve the quality of care for elderly patients with epilepsy who are cared for at home.
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Affiliation(s)
- Yasemin Şahin Yıldız
- Department of Home Patient Care, Vocational College of Health Services, University of Bartın, Bartın, Turkey.
| | - Hanifi Dülger
- Department of Midwifery, Faculty of Health Sciences, University of Bartın, Bartın, Turkey.
| | - Elçin Sebahat Kasapoğlu
- Department of Elderly Care, Vocational College of Health Services, University of Bartın, Bartın, Turkey.
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Viny M, Trevino AY, Bouldin ED, Kalvesmaki A, Roghani A, Pugh MJ. Caregiver burden and COVID-19: How epilepsy caregivers experienced the pandemic. Epilepsy Behav 2023; 141:109151. [PMID: 36907084 PMCID: PMC9968611 DOI: 10.1016/j.yebeh.2023.109151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Caregivers of adults with epilepsy face unique challenges, yet most studies focus on the impact of epilepsy on those living with the condition, rather than the impact on caregivers. Our objective was to evaluate whether caregivers' pandemic-related changes and experiences - namely those related to their health, healthcare access, and well-being - were associated with their caregiving burden. METHODS Caregivers of adults with epilepsy (n = 261) were recruited through Qualtrics Panels to participate in an online survey examining health, well-being, COVID-19 experiences, and caregiver burden from October-December, 2020. The burden was measured using the Zarit 12-item measure; the clinically significant burden was defined as a score greater than 16. Adjustments were made to account for burden scores related to exposures of interest. Chi-square tests, t-tests, and generalized linear regression models were used to compare cross-sectional associations between COVID-19 experiences and burden. RESULTS Over half (57.9%) of caregivers had clinically significant caregiver burden. Most reported increased anxiety (65%), stress (64%), and sense of social isolation (58%) during the pandemic. Many caregivers reported that their sense of control over their life (44%) and their use of healthcare changed (88%) due to COVID-19. In adjusted models, caregivers who reported increased anger, increased anxiety, decreased sense of control, or changes in healthcare utilization during COVID-19 had about twice the odds of having clinically significant caregiver burden compared to caregivers who did not report changes. DISCUSSION Changes experienced by caregivers of adults with epilepsy during the pandemic were strongly associated with clinically significant levels of caregiver burden. These findings demonstrate the link between mass-level events, such as a pandemic, the burden caregivers of adults with epilepsy may carry, and subsequent psychological outcomes. CONCLUSION Caregivers of adults with epilepsy may need support to reduce the negative impact of COVID-19-related experiences and should be connected to healthcare and resources that can help alleviate their burden.
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Affiliation(s)
- Mikayla Viny
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Amira Y Trevino
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Department of Educational Psychology, University of Utah College of Education, Salt Lake City, UT, United States.
| | - Erin D Bouldin
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Andrea Kalvesmaki
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States.
| | - Ali Roghani
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Mary Jo Pugh
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States.
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Musekwa OP, Makhado L, Maphula A. Caregivers' and Family Members' Knowledge Attitudes and Practices (KAP) towards Epilepsy in Rural Limpopo and Mpumalanga, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5222. [PMID: 36982132 PMCID: PMC10048962 DOI: 10.3390/ijerph20065222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
Epilepsy, a common neurological disease, has a significant impact on people living with epilepsy (PLWE), their caregivers, and their family members. Research has consistently shown that the quality of life of PLWE is low. To expand on this knowledge, a non-experimental quantitative survey study was conducted to explore the knowledge, attitudes, and practices (KAP) of caregivers and family members towards epilepsy and epilepsy-related seizures. The study sample consisted of 519 participants from two South African provinces (Limpopo and Mpumalanga), mostly aged 26-35 years. The study revealed that most respondents in Limpopo had no formal education, whereas in Mpumalanga, most had a secondary education. Most respondents (32.4%) reported always using a spoon to prevent tongue biting during seizures. However, 62.4% of respondents reported feeling unprepared to handle an epileptic seizure. Additionally, the majority (54.7%) showed a moderate level of knowledge about epilepsy. Many respondents had a negative attitude towards epilepsy, and there was uncertainty about proper practices during a seizure. In summary, the research highlights unsatisfactory knowledge and practices towards epilepsy and emphasizes the need for increased education and awareness among caregivers and family members. Significant educational investment is needed from medical services to improve epilepsy care, knowledge, and attitudes.
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Affiliation(s)
- Ofhani Prudance Musekwa
- Department of Psychology, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Lufuno Makhado
- Faculty Deans Office, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Angelina Maphula
- Department of Psychology, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
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Ostendorf AP, Axeen ET, Eschbach K, Fedak Romanowski E, Morgan LA, Gross P, Narayanan UG, Glader L, Noritz G. Epilepsy and proxy-reported health-related quality of life in children and young people with non-ambulatory cerebral palsy. Dev Med Child Neurol 2023; 65:200-206. [PMID: 35820144 PMCID: PMC10084160 DOI: 10.1111/dmcn.15336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 01/04/2023]
Abstract
AIM To assess the association between epilepsy characteristics and proxy-reported health-related quality of life (HRQoL) in children and young people with non-ambulatory cerebral palsy (CP) and seizures. METHOD This was a cross-sectional study of 164 children and young people (74 females, 90 males; mean age 10 years 6 months, range 2-21 years, SD 5 years 5 months). Caregivers completed the Child Health Index of Life with Disabilities (CPCHILD) in an outpatient setting. We utilized univariable linear regression and multivariable modeling to study relationships between variables and CPCHILD scores. RESULTS Gross Motor Function Classification System levels were 37% IV and 63% V. Sociodemographic factors included the Child Opportunity Index (median 51, interquartile range [IQR] 25-80). A median of 2 (IQR 1-3) antiseizure medications (ASMs) were used, and days with seizures ranged from 0 (30%) to 28 (20%) days in the previous 4 weeks. Total CPCHILD scores decreased 2.3 points for each ASM (95% confidence interval [CI] -4.1 to -0.42). Compared to persons with focal epilepsy, those with generalized epilepsy had lower total CPCHILD scores (-5.7; 95% CI -11 to -0.55). Number of days with seizures was not associated with total CPCHILD scores. INTERPRETATION Proxy-reported HRQoL was affected by epilepsy-specific features in children and young people with severe CP. WHAT THIS PAPER ADDS Health-related quality of life (HRQoL) was lower with increasing numbers of antiseizure medications. Overall quality of life (QoL) scores were lower by a similar amount, independent of seizure frequency. HRQoL was lower in persons with recent hospital admissions for epilepsy.
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Affiliation(s)
- Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Erika T Axeen
- Departments of Neurology and Pediatrics, University of Virginia, Virginia, USA
| | - Krista Eschbach
- Children's Hospital Colorado, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Erin Fedak Romanowski
- Department of Pediatrics, Division of Pediatric Neurology, CS Mott Children's Hospital and University of Michigan Health, Ann Arbor, Michigan, USA
| | - Lindsey A Morgan
- Seattle Children's Hospital and University of Washington, Washington, USA
| | - Paul Gross
- University of Utah, Salt Lake City, Utah, USA
| | - Unni G Narayanan
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Laurie Glader
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
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Ren Z, Yang C, Yu D. Cognitive deficiency, parental relationship, and coping strategies are related with anxiety and depression among parents of children with epilepsy. Chronic Dis Transl Med 2022; 8:229-237. [PMID: 36161201 PMCID: PMC9481879 DOI: 10.1002/cdt3.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background The diagnosis of epilepsy in a child often and understandably causes psychological adjustment difficulties in the parents. To help parents of children with epilepsy cope with stress, it is important to understand how parents cope with the sickness of their child. The objective of this study was to assess factors related to the state of anxiety and depression among parents of children with epilepsy. Methods The present study was a cross-sectional study, and the data were collected through an anonymous, Internet-based survey platform between October 2018 and October 2019 from 250 participants aged 22-65 years. Participants were invited to fill questionnaires include socioeconomic questionnaire, anxiety, depression, and coping strategies scale. Result Among the parents of children with epilepsy, 48.8% (122/250) had depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score >4) and 46.4% (116/250) had anxiety symptoms (7-item Generalized Anxiety Disorder [GAD-7] score >5). Depression among parents of children with epilepsy was significantly associated with comorbidity (odds ratio [OR] = 0.392, 95% CI = 0.182-0.846), a poor parental relationship (OR = 0.283, 95% CI = 0.130-0.614), positive coping (OR = 0.947, 95% CI = 0.903-0.992), and negative coping (OR = 1.287, 95% CI = 1.179-1.405). Anxiety among parents of children with epilepsy was significantly associated with a poor parental relationship (OR = 0.416, 95% CI = 0.207-0.835) and negative coping (OR = 1.155, 95% CI = 1.087-1.228). Conclusions The present study indicates the importance of couple support and providing effective coping to make parents of children with epilepsy more resilient in the presence of negative life events, especially for parents of children with comorbidity with cognitive deficiency.
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Affiliation(s)
- Zhengjia Ren
- Department of Clinical PsychologyThe Third Affiliated Hospital of Chongqing Medical UniversityChongqing401120China
| | - Chunsong Yang
- Department of Pharmacy, Evidence‐based Pharmacy Center, West China Second HospitalSichuan UniversityChengduSichuan610041China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of EducationSichuan UniversityChengduSichuan610041China
| | - Dan Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of EducationSichuan UniversityChengduSichuan610041China
- Department of Medical Genetics, West China Second HospitalSichuan UniversityChengduSichuan610041China
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Enhancing the wellness of caregivers of individuals with epilepsy: The effects of a brief stress management course. Epilepsy Behav 2022; 133:108745. [PMID: 35716427 DOI: 10.1016/j.yebeh.2022.108745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine whether a brief stress management video can improve the quality of life of caregivers of persons with epilepsy (PWE). METHODS Thirty-three adult caregivers of PWE who scored 5 or higher on the Caregiver Self-Assessment Questionnaire (CSAQ) completed a 30-min stress management video. This was preceded by a pre-intervention assessment, followed by post-intervention assessment at 1 month, and a delayed post-intervention assessment evaluation 3 months after video was viewed. Measures of program acceptability were also obtained. RESULTS There was significant improvement when comparing pre- and post-intervention CSAQ scores. This improvement was sustained at 3 months post intervention. Measures of program acceptability were favorable. CONCLUSION A brief stress management course can help improve the quality of life of caregivers of PWE.
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12
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Spreadbury JH, Young A, Kipps CM. A Comprehensive Literature Search of Digital Health Technology Use in Neurological Conditions: Review of Digital Tools to Promote Self-management and Support. J Med Internet Res 2022; 24:e31929. [PMID: 35900822 PMCID: PMC9377435 DOI: 10.2196/31929] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 03/13/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of digital health technology to promote and deliver postdiagnostic care in neurological conditions is becoming increasingly common. However, the range of digital tools available across different neurological conditions and how they facilitate self-management are unclear. OBJECTIVE This review aims to identify digital tools that promote self-management in neurological conditions and to investigate their underlying functionality and salient clinical outcomes. METHODS We conducted a search of 6 databases (ie, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, and the Cochrane Review) using free text and equivalent database-controlled vocabulary terms. RESULTS We identified 27 published articles reporting 17 self-management digital tools. Multiple sclerosis (MS) had the highest number of digital tools followed by epilepsy, stroke, and headache and migraine with a similar number, and then pain. The majority were aimed at patients with a minority for carers. There were 5 broad categories of functionality promoting self-management: (1) knowledge and understanding; (2) behavior modification; (3) self-management support; (4) facilitating communication; and (5) recording condition characteristics. Salient clinical outcomes included improvements in self-management, self-efficacy, coping, depression, and fatigue. CONCLUSIONS There now exist numerous digital tools to support user self-management, yet relatively few are described in the literature. More research is needed to investigate their use, effectiveness, and sustainability, as well as how this interacts with increasing disability, and their integration within formal neurological care environments.
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Affiliation(s)
- John Henry Spreadbury
- Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Alex Young
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Christopher Myles Kipps
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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13
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Ruiz-Lozano RE, de la Rosa-Pacheco S, Hernández-Camarena JC, Garza-Garza LA, Davila-Cavazos O, Dominguez-Varela IA, Quiroga-Garza ME, Rodriguez-Garcia A. Burden and depression among informal caregivers of visually impaired patients in Mexico. Disabil Health J 2022; 15:101284. [PMID: 35337783 DOI: 10.1016/j.dhjo.2022.101284] [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: 09/05/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The needs of informal caregivers who provide care to family relatives with visual impairment are often neglected, resulting in burden and depression. OBJECTIVE To determine the degree of burden and the prevalence of major depression experienced by caregivers, defined as non-paid family relatives, of legally blind individuals in a Mexican population. METHODS Observational, single-center, cross-sectional study in adults providing care to their family relatives with visual impairment (visual acuity ≤ 20/200 in the best eye for at least 3 months). According to visual impairment degree, care provided included activities of daily living (ADL) and instrumental ADL. Burden of care was evaluated with the Zarit burden interview (ZBI)-22 and the prevalence of major depression was determined by the patient health questionnaire (PHQ)-9. RESULTS 115 patients and 115 caregivers were included. Male caregivers had significantly higher ZBI-22 (28.7 ± 15.5 vs. 19.2 ± 12.6, p = 0.001) and PHQ-9 (10.0 ± 5.5 vs. 5.3 ± 5.1, p < 0.001) scores than females. Likewise, parent caregivers of adult children and the hours of daily care were significantly associated with higher burden and depression scores. A significant linear correlation between ZBI-22 and PHQ-9 scores in caregivers was also found (r = 0.649, p < 0.001). CONCLUSIONS Male caregivers, parent caregivers of adult children, and caregivers providing greater hours of care were at higher risk of burden and depression. Upon diagnosis of visual impairment, adults providing care to visually impaired family relatives should be screened for burden and depression and referred to a mental health specialist when necessary. Tailored interventions targeting the caregivers' needs are required to reduce burden and depression.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Sylvia de la Rosa-Pacheco
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Av. I. Morones Prieto No. 3000 Pte. Col. Sertoma, Monterrey, NL, CP, 64710, Mexico.
| | - Julio C Hernández-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Lucas A Garza-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Osvaldo Davila-Cavazos
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Irving A Dominguez-Varela
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Manuel E Quiroga-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Av. Batallon de San Patricio #112, Col. Real de San Agustin, San Pedro Garza Garcia, NL, CP, 66278, Mexico.
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14
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Tsamakis K, Teagarden DL, Villarreal HK, Morton ML, Janocko NJ, Groover O, Loring DW, Drane DL, Karakis I. Depression and Anxiety in Adult Persons With Epilepsy and Their Caregivers: A Survey-Based Study at a Tertiary Care Center. J Nerv Ment Dis 2022; 210:212-218. [PMID: 34719659 DOI: 10.1097/nmd.0000000000001436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study evaluated the rates of depression and anxiety and their determinants in adult persons with epilepsy and their caregivers. Both completed surveys about demographic, disease-related, and psychosocial characteristics. One hundred patients and caregivers participated. A mood disorder was present in 89% of patients and 56% of caregivers. In the univariate analysis, the presence of mood disorder in the patient was associated with being unmarried, unemployed, frequent hospitalizations, side effects from polypharmacy, patient stigma, patient quality of life, caregiver anxiety, and caregiver burden. In the multivariate analysis, medication side effects sustained as an important determinant. In the univariate analysis, the presence of mood disorder in the caregiver was associated with seizure frequency, patient anxiety, patient quality of life, caregiver stigma, and caregiver burden. In the multivariate analysis, patient anxiety level and caregiver burden sustained as important determinants. Adult persons with epilepsy and their caregivers experience high rates of mood disorders, explained by certain clinical factors.
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15
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Factors associated with caregiver burden of adults with epilepsy in a middle-income country. Seizure 2022; 98:1-7. [DOI: 10.1016/j.seizure.2022.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
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16
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Nagel M, Weidner V, Schulz S, Marquardt JU, Galle PR, Schattenberg JM, Nguyen-Tat M, Wörns MA, Labenz C. Continued alcohol consumption and hepatic encephalopathy determine quality of life and psychosocial burden of caregivers in patients with liver cirrhosis. Health Qual Life Outcomes 2022; 20:23. [PMID: 35135582 PMCID: PMC8822635 DOI: 10.1186/s12955-022-01923-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/18/2022] [Indexed: 12/22/2022] Open
Abstract
Background Patients with liver cirrhosis suffer from significantly reduced health-related quality of life and are often dependent on support from caregivers. In this context, caregivers often suffer from impaired quality of life (QoL) as well as psychosocial burden (PB). The aim of the present study was to identify factors influencing QoL and PB of caregivers in order to improve the social care of patients and caregivers. Methods In this cross-sectional study, 106 patients with liver cirrhosis and their caregivers were included. (Health-related) QoL was surveyed in patients (CLDQ) and caregivers (SF-36) and PB was determined by Zarit Burden Interview. Results Alcohol related liver cirrhosis (55%) was the predominant etiology of liver cirrhosis and the median MELD of the cohort was 14. QoL did not differ between patients with and without alcohol-related liver cirrhosis (p = 0.6). In multivariable analysis, continued alcohol consumption (p = 0.020), a history of hepatic encephalopathy (HE) (p = 0.010), poorer QoL of patients (p = 0.030) and poorer QoL of caregivers (p = 0.005) were associated with a higher PB of caregivers. Factors independently associated with poorer QoL of caregivers were continued alcohol consumption (p = 0.003) and a higher PB of caregivers (p = 0.030). Conclusion Caregivers of patients with liver cirrhosis suffer from impaired QoL and PB, especially in case of continued alcohol consumption or the occurrence of HE. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01923-z.
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Affiliation(s)
- Michael Nagel
- Department of Internal Medicine I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany. .,Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany. .,Department of Gastroenterology, Hematology, Oncology, and Endocrinology, Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Germany.
| | - Vanessa Weidner
- Department of Internal Medicine I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sina Schulz
- Department of Internal Medicine I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jens U Marquardt
- First Department of Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Metabolic Liver Research Program, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marc Nguyen-Tat
- Medical Center Kempten, Department of Gastroenterology, Kempten, Germany
| | - Marcus-Alexander Wörns
- Department of Gastroenterology, Hematology, Oncology, and Endocrinology, Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Germany
| | - Christian Labenz
- Department of Internal Medicine I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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17
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Turan GB, Dayapoğlu N, Özer Z. Evaluation of care burden and caregiving preparedness in caregivers of patients with epilepsy: A sample in eastern Turkey. Epilepsy Behav 2021; 124:108370. [PMID: 34717246 DOI: 10.1016/j.yebeh.2021.108370] [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: 08/04/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
AIM This study was conducted to evaluate the care burden and caregiving preparedness in caregivers of patients with epilepsy. METHODS This descriptive, cross-sectional study evaluated the caregivers of patients with epilepsy who were referred to the neurology outpatient clinic of a university hospital in Erzurum, eastern Turkey, between February 2020 and February 2021. The study was carried out with 147 volunteers among the patients with epilepsy who were referred to the neurology outpatient clinic between the specified dates. The data were collected with Caregiver Question Form, the Brief Disability Questionnaire (BDQ), the Burden Interview (BI), and the Preparedness for Caregiving Scale (PCS). RESULTS The mean BI score of the caregivers who participated in the study was 43.14 ± 18.08, their mean PCS score was 14.12 ± 7.76, and their mean BDQ score was 10.53 ± 4.65. In the regression analysis conducted, it was found that being married, having little knowledge of patient care, undertaking all of the roles in caregiving and having caregiving duration of 24 months and longer had a negative effect on PCS total score, while having an undergraduate degree and higher had a positive significant effect. It was found that having an undergraduate degree and higher had a negative effect on BI total score, while all of the roles undertaken in caregiving had a positive significant effect on BI total score. It was found that PCS had a negative significant effect on BI total score (p < 0.001). CONCLUSION Caregivers of patients with epilepsy had a moderate level of burden and caregiving preparedness, and the patients cared for had a moderate level of disability. Caregiver burden increased as disability of patients with epilepsy and the tasks undertaken in caregiving increased, whereas burden decreased as caregiver education and caregiving preparedness increased.
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Affiliation(s)
| | | | - Zülfünaz Özer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
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18
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Rady A, Elfatatry A, Molokhia T, Radwan A. Psychiatric comorbidities in patients with psychogenic nonepileptic seizures. Epilepsy Behav 2021; 118:107918. [PMID: 33735815 DOI: 10.1016/j.yebeh.2021.107918] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES) are major challenges for diagnosis and management. The heterogeneity of psychogenic seizures is attributed to diverse psychopathological comorbidities, and the causal relationship between PNES and underlying psychopathologies is still enigmatic. OBJECTIVE Our objective was to study psychiatric comorbidities and personality constructs in patients with PNES and compare them to a control group of patients with epilepsy. METHOD We randomly recruited 33 patients with PNES and 33 patients with epilepsy. All patients completed the Mini-International Neuropsychiatric Interview (MINI) to screen for psychiatric comorbidities, the Structured Clinical Interview for psychiatric disorders in Axis II (SCID II) to screen for personality disorders, and Goldberg's International Personality Item Pool (IPIP) Big Five personality questionnaire to study the psychological constructs of extroversion-introversion, agreeableness, conscientiousness, emotional stability-neuroticism, and intellect. RESULT Mood and anxiety disorders were highly prevalent in patients with PNES (72.7% and 54.5%, respectively); however, the prevalence of only cluster B personality disorder was higher in patients with PNES (69.7%) compared to 33.3% among patients with epilepsy (p < 0.05). Screening for personality disorders using SCID II showed that the prevalence of borderline and depressive personality disorders was significantly higher in patients with PNES (p < 0.001). Patients with psychogenic seizures were more likely to be receiving polydrug therapy (75.8%) compared to patients with epileptic seizures (45.5%); this difference was statistically significant (p < 0.05). CONCLUSION Psychiatric comorbidities are highly prevalent among patients with PNES.
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Affiliation(s)
- Ahmed Rady
- Department of Psychiatry, Alexandria University School of Medicine, Egypt.
| | - Amr Elfatatry
- Department of Neurology, Alexandria University School of Medicine, Egypt
| | - Tarek Molokhia
- Department of Psychiatry, Alexandria University School of Medicine, Egypt
| | - Aya Radwan
- Department of Psychiatry, Alexandria University School of Medicine, Egypt
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19
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Onder H, Ulusoy EK, Baydar C, Kiraz M, Orun MO, Kiliçarslan Z, Basol M, Tantik A. Depression, anxiety levels and sleep quality indexes among the spouses of people with epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:420-428. [PMID: 34037102 PMCID: PMC9394562 DOI: 10.1590/0004-282x-anp-2020-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Psychiatric problems and sleep disturbances are comorbidities that are frequently encountered among people with epilepsy. However, their presence among the spouses of peoples with epilepsy remains to be elucidated. OBJECTIVE The objective of this study was to evaluate the spouses of people with epilepsy (PWE), with and without a history of seizures during sleep, in terms of depression, anxiety and sleep quality. METHODS This prospective, cross-sectional study was conducted in three groups of 18 to 65-year-olds. Group 1 consisted of healthy spouses of 127 healthy volunteers without any known neurological disease; group 2 comprised spouses of 63 PWE who had no history of seizure during sleep; and group 3 consisted of spouses of 63 PWE who had a history of at least one seizure during sleep in the course of the previous year. Questionnaires seeking demographic data and the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory and Beck Anxiety Inventory were applied to all participants. RESULTS The depression scores of the group of spouses of PWE were higher than those of the control group and were higher in group 3 than in group 2 (p = 0.017). The anxiety scores of the group of spouses of PWE were significantly higher than those of the control group, but no difference in anxiety scores was found between group 2 and group 3 (p = 0.170). The mean PSQI score of group 3 was higher than that of group 2 (p = 0.029). However, regression analyses did not show any difference between these groups. CONCLUSION We found that the PSQI scores, which reflected sleep quality, were higher among the spouses of PWE who had seizures during sleep and who had more severe epilepsy.
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Affiliation(s)
- Halil Onder
- Yozgat City Hospital, Department of Neurology, Yozgat, Turkey
| | | | - Caner Baydar
- Van Training and Research Hospital, Department of Neurology, Van, Turkey
| | - Mustafa Kiraz
- Van Training and Research Hospital, Department of Neurology, Van, Turkey
| | - Muhammet Okay Orun
- Van Training and Research Hospital, Department of Neurology, Van, Turkey
| | | | - Merve Basol
- Hacettepe University Medical School, Department of Biostatistics, Ankara, Turkey
| | - Aygul Tantik
- Taksim Training and Research Hospital, Department of Neurology, Istanbul, Turkey
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20
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Takeda K, Yamashita S, Taniguchi G, Kuramochi I, Murakami M, Kashiwagi H, Hashimoto R, Hirabayashi N, Okada T. Criminal victimization of people with epilepsy: Sixteen criminal judgments in Japan between 1990 and 2019. Epilepsy Behav 2021; 118:107912. [PMID: 33744796 DOI: 10.1016/j.yebeh.2021.107912] [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: 01/17/2021] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
Criminal behavior by people with epilepsy (PWE) has often been discussed. However, there are limited studies on criminal victimization of PWE-in particular, how such victimizations occur. We identified criminal cases involving victims with epilepsy using databases containing criminal judgments and found 16 such cases between 1990 and 2019. Seven were homicide cases, including four filicide cases. In the four filicide cases, all the perpetrators had the intention of homicide-suicide; all the victims had intellectual disabilities or cerebral palsy; two of these victims had acted violently toward the family; and two mothers who perpetrated the crime against the victims had depression. It seemed that the comorbidities and problem behaviors of the victims were more strongly related to serious crimes by family caregivers than the epilepsy itself. To prevent victimization caused by family caregivers, reducing their stress levels is important. Defendants sometimes argued against objective evidence of a crime, claiming that epileptic seizure of PWE caused or was related to the death of victims. Legal and medical professionals involved in determining the manner of death need careful evaluation when sudden deaths of PWE occur.
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Affiliation(s)
- Koji Takeda
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan; Section of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan.
| | - Shingo Yamashita
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Go Taniguchi
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Izumi Kuramochi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 350-0844, Japan
| | - Maki Murakami
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Hiroko Kashiwagi
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan; Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - Naotsugu Hirabayashi
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Takayuki Okada
- Section of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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21
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Bapat DA, Shankar A. A review of caregiver distress in epilepsy in India: Current issues and future directions for research. Epilepsy Behav 2021; 116:107787. [PMID: 33549937 DOI: 10.1016/j.yebeh.2021.107787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 12/21/2022]
Abstract
India is home to a large number of individuals with epilepsy, with many of these patients having high care needs. Owing to limited infrastructural support and prevalent cultural attitudes, most of these individuals are cared for by their families. Such informal caregiving is often associated with poor physical and psychological outcomes, but the state of caregivers of people with epilepsy in India remains largely ignored. This review summarizes currently available research on distress among caregivers for people with epilepsy in India. A review of 20 studies published till July 2020 revealed significant burden in this population. Caregiving was reported to negatively impact one's physical and mental health, overall family functioning, and financial status. A range of seizure-related variables were found to be associated with greater perceived burden, with the impact of patient characteristics and psychosocial factors on burden being relatively unexplored. Much of the research identified was characterized by methodological limitations such as small sample sizes, exclusion of patients with comorbidities, and a failure to distinguish between carers of adult and pediatric populations, thus overshadowing the specific needs of each group. There is a need for larger, well-designed studies that focus on culture-specific psychological and social factors in the Indian context of caregiving for people with epilepsy.
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Affiliation(s)
- Deepa Anand Bapat
- FLAME University, Pune, India; Bajaj Allianz Centre for Comprehensive Epilepsy Care, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
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22
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Jabbarinejad R, Cohen-Zimerman S, Wagner AK, Grafman J. Determinants of caregiver burden in male patients with epilepsy following penetrating traumatic brain injury. Epilepsy Behav 2021; 116:107768. [PMID: 33567399 DOI: 10.1016/j.yebeh.2021.107768] [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: 11/29/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We determined burden of caring for patients with post-traumatic epilepsy (PTE) following penetrating traumatic brain injury (TBI) and identified factors predicting higher burden. METHOD We assessed 331 caregiver-veteran dyads in Phase 2 (136 PTE, 136 non-PTE, and 59 HC dyads), 133 in Phase 4 (47 PTE, 56 non-PTE, and 30 HC dyads) - 30 years later, and 46 dyads in the follow-up study (18 PTE, 19 non-PTE, and 9 HC). Caregiver's burden was measured by Zarit Burden Index and a questionnaire. Veterans completed demographic, mental and physical well-being, quality-of-life, and medical-related information. Caregivers provided information about burden and their assessments of cognitive decline and neuropsychiatric status of the veterans. RESULTS PTE caregivers perceived significantly more burden than comparison groups at all phases. Bivariate analyses revealed that caregiver distress due to the veteran's neuropsychiatric state including cognitive decline, apathy, and disinhibition and the veteran's characteristics including older age at epilepsy onset and role limitation due to physical problems were associated with higher burden. Finally, we revealed disinhibition distress, and role imitation due to physical problems as the predictors in a model of caregiver burden. CONCLUSION Elevated PTE caregiver burden is persistent across the life span suggesting that caregivers could benefit from counseling and targeted psychosocial interventions to reduce their burden.
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Affiliation(s)
- Roxana Jabbarinejad
- Cognitive Neuroscience Laboratory, Brain Injury Research, Think+Speak Lab, Shirley Ryan Ability Lab, Northwestern University, Chicago, IL, USA.
| | - Shira Cohen-Zimerman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Think+Speak Lab, Shirley Ryan Ability Lab, Northwestern University, Chicago, IL, USA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Think+Speak Lab, Shirley Ryan Ability Lab, Northwestern University, Chicago, IL, USA; Departments of Neurology, Psychiatry, and Cognitive Neurology & Alzheimer's Disease, Feinberg School of Medicine, Department of Psychology, Northwestern University, Chicago, IL, USA.
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Pokharel R, Poudel P, Lama S. Quality of life among caregivers of children with epilepsy: A cross-sectional study at Eastern Nepal. Epilepsia Open 2021; 6:120-126. [PMID: 33681655 PMCID: PMC7918323 DOI: 10.1002/epi4.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 11/05/2022] Open
Abstract
Objective To assess the quality of life among caregivers of children with epilepsy in a tertiary care center of eastern Nepal. Methods A cross-sectional study was conducted among primary caregivers of children with epilepsy, who accompanied their child in child neurology clinic. Consecutive sampling was done, and 106 respondents were interviewed. Data were collected using World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale and analyzed using Statistical Package for the Social Sciences. Descriptive and Inferential statistics were applied. Results Mean WHOQOL-BREF score was 82.25 {standard deviation (SD) ±12. 11}. Transformed scores (0-100) for each domain were 57.98 ± 14.55 in physical, 55.87 ± 13.16 in psychological, 53.12 ± 13.42 in social, and 52.52 ± 13.04 in environmental domain. Mean score for overall perception of quality of life (QOL) was 2.71 ± 0.79 and was 3.12 ± 0.75 for overall perception of health. Living below poverty line (P = .03) and poor seizure control status of children (P = .46) were significantly associated with lower total QOL score. Living below poverty line was significantly associated with low social relationship (P = .003) and environment domain (<0.001) scores. Significance Epilepsy has a multifaceted impact on the lives of affected people. Caring children with epilepsy is associated with enormous psychosocial effects on parents and family members. Caregivers' QOL may affect the treatment and outcome of epilepsy in children. Given the consideration to scarcity of this kind of literature in Nepalese context, this study was conducted.
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Affiliation(s)
- Rita Pokharel
- Department of Psychiatric NursingBP Koirala Institute of Health SciencesDharanNepal
| | - Prakash Poudel
- Department of Paediatrics and Adolescent MedicineBP Koirala Institute of Health SciencesDharanNepal
| | - Sami Lama
- Department of Psychiatric NursingBP Koirala Institute of Health SciencesDharanNepal
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Hussain SA, Ortendahl JD, Bentley TGK, Harmon AL, Gupta S, Begley CE, Khilfeh I, Knoth RL. The economic burden of caregiving in epilepsy: An estimate based on a survey of US caregivers. Epilepsia 2020; 61:319-329. [PMID: 31953846 DOI: 10.1111/epi.16429] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The burden of caregiving for persons with epilepsy (PWEs) has not been examined previously in the United States. We assessed the clinical impact and direct and indirect economic costs for caregivers of PWEs. METHODS An internet survey of 500 caregivers of PWEs was conducted from May to July 2015 using a combination of validated instruments and questions designed specifically for this survey. Caregivers were stratified by PWE age (adult/child) and disease severity (low: 0 vs high: 1 + seizures in the prior month). Annual self-reported direct and indirect costs were reported per caregiver and extrapolated to all US caregivers. The economic burden of caregiving for PWEs was defined as the difference between costs for caregivers and the general population. RESULTS Caregivers reported that PWEs averaged 11.4 seizures in the prior month. Eighty percent of respondents were female and the average age was 44.3. Since becoming a caregiver, many reported anxiety (52.8%), depression (41.0%), and insomnia (30.8%). Annual mean direct medical costs for caregivers of children with low vs high seizure frequency were $4344 and $10 162, respectively. Costs for caregivers of adult PWEs were $4936 and $8518. Mean indirect costs associated with caregiving for a child with low vs high seizure frequency were $20 529 and $40 137; those for caregivers of an adult were $13 981 and $28 410. The cost estimates are higher vs the general US population; annual per-person healthcare utilization costs were $2740 and productivity loss costs were $5015. When extrapolating to the US population of PWE caregivers, annual costs exceeded $62 billion vs $14 billion for the general population, resulting in a caregiver burden of nearly $48 billion. SIGNIFICANCE The clinical and economic burden of caregivers for PWE were substantial, and greatest for those caring for children with frequent seizures. The impact on caregivers should be considered when estimating the value of interventions that control epilepsy.
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Affiliation(s)
- Shaun A Hussain
- Division of Pediatric Neurology, UCLA Mattel Children's Hospital and David Geffen School of Medicine, Los Angeles, California
| | - Jesse D Ortendahl
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | - Tanya G K Bentley
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | - Amanda L Harmon
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
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25
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Burden in caregivers of adults with epilepsy in Asian families. Seizure 2019; 71:132-139. [DOI: 10.1016/j.seizure.2019.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/13/2022] Open
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Wardrope A, Green B, Norman P, Reuber M. The influence of attachment style and relationship quality on quality of life and psychological distress in carers of people with epileptic and nonepileptic seizures. Epilepsy Behav 2019; 93:16-21. [PMID: 30780076 DOI: 10.1016/j.yebeh.2019.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Seizure disorders affect not only the individual living with seizures, but also those caring for them. Carer-patient relationships may be influenced by, and have an influence on, some aspects of living with seizure disorders - with potentially different interactions seen in epilepsy and psychogenic nonepileptic seizures (PNES). OBJECTIVES We studied the influence of patient and carer attachment style and relationship quality on carer wellbeing and psychological distress, and explored whether these associations differ between carers for people with epilepsy and for those with PNES. METHODS Consecutive adult patients with epilepsy (N = 66) and PNES (N = 16) and their primary informal carers completed questionnaires about relationship quality, attachment style, and psychopathological symptom burden. We used correlation analysis to identify associations between relationship quality, attachment style, and carer depression, anxiety, and wellbeing; and to explore differences in these associations between carers for people with epilepsy and for those with PNES. RESULTS Overall, 25.3% of carers for people with epilepsy or PNES had scores above the clinical cutoff for depression and 39.6% for anxiety; significantly more carers for people with PNES reported clinically significant depression (47.1% vs. 20.0%), but there was no difference in anxiety rates likely to be of clinical relevance. Correlations differed significantly between carers for people with epilepsy and for those with PNES in terms of patient quality of life and carer anxiety (rE = -0.577, rPNES = -0.025); seizure severity and carer depression (rE = 0.248, rPNES = -0.333) and mental wellbeing (rE = -0.356, rPNES = 0.264); patient depression and carer anxiety (rE = 0.387, rPNES = -0.266); and patient anxious attachment and carer anxiety (rE = 0.382, rPNES = 0.155). SIGNIFICANCE Clinically evident levels of psychological distress are prevalent among carers for people with epilepsy and PNES. Clinical and relationship variables affect carer quality of life differently depending on whether care is provided for individuals with epilepsy or PNES.
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Affiliation(s)
- Alistair Wardrope
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
| | - Becky Green
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Paul Norman
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom
| | - Markus Reuber
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom; Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
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27
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Bao X, Tian X, Yang C, Li Y, Hu Y. Association between ambient air pollution and hospital admission for epilepsy in Eastern China. Epilepsy Res 2019; 152:52-58. [PMID: 30909052 DOI: 10.1016/j.eplepsyres.2019.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/26/2019] [Accepted: 02/24/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND We aimed to study the short-term association between air pollutants and hospitalization for epilepsy in 47 hospitals from 10 cities in eastern China. METHOD We identified hospital epilepsy admissions in 2014 and 2015. A conditional Poisson regression model was used to examine the association between air pollutants and hospital admission, with temperature and relative humidity adjusted using the natural spline (ns) function. Pollutants included sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matter (PM). The association was stratified by sex, age, and geographic region in single-pollutant and two-pollutant models. RESULTS An interquartile (IQR) increase of NO2 and CO on the concurrent day is correlated with an increased admission of 2.0% (0.5%, 3.6%) and 1.1% (0.1%, 2.1%), respectively. The association is stronger in children (≤18 years) and in northern China, but did not vary with sex. A positive association was also observed on the previous day for CO [1.5%, 95% confidence interval (CI): 0.3%, 2.6%], NO2 (2.5%, 95% CI: 0.6%, 4.3%), and PM2.5 (1.32%, 95% CI: 0.16%, 2.48%). Moving average concentration of 7 days for all pollutants was associated with decreased admission (CO: -1.29%, NO2: -0.4.69%, SO2:-2.12%, PM2.5:-0.98%, PM10:-1.70%). CONCLUSION Exposures to NO2 and CO on concurrent days, and PM2.5 on the previous day, are associated with increased epilepsy hospitalization, whereas cumulative exposure appeared protective.
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Affiliation(s)
- Xiaoyuan Bao
- Medical Informatics Center, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Xin Tian
- Department of Health Policy and Administration, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Chao Yang
- Renal Division, Peking University First Hospital, Peking Uni versity Institute of Nephrology, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Yan Li
- Department of Hospital Management, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Yonghua Hu
- Medical Informatics Center, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China; Department of Epidemiology and Biostatistics, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
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28
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The neurology-psychiatry interface in epilepsy. Ir J Psychol Med 2018; 38:9-15. [PMID: 33715646 DOI: 10.1017/ipm.2018.49] [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] [Indexed: 11/05/2022]
Abstract
Epilepsy and mental illness have a bidirectional association. Psychiatrists are likely to encounter epilepsy as comorbidity. Seizures may present as mental illness. Equally, the management of psychiatric conditions has the potential to destabilise epilepsy. There is a need for structured epilepsy awareness and training amongst psychiatrists. This paper outlines key considerations around diagnosis, treatment and risk while suggesting practical recommendations.
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van Dijk RM, Di Liberto V, Brendel M, Waldron AM, Möller C, Gildehaus FJ, von Ungern-Sternberg B, Lindner M, Ziegler S, Hellweg R, Gass P, Bartenstein P, Potschka H. Imaging biomarkers of behavioral impairments: A pilot micro-positron emission tomographic study in a rat electrical post-status epilepticus model. Epilepsia 2018; 59:2194-2205. [PMID: 30370531 DOI: 10.1111/epi.14586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In patients with epilepsy, psychiatric comorbidities can significantly affect the disease course and quality of life. Detecting and recognizing these comorbidities is central in determining an optimal treatment plan. One promising tool in detecting biomarkers for psychiatric comorbidities in epilepsy is positron emission tomography (PET). METHODS Behavioral and biochemical variables were cross-correlated with the results from two μPET scans using the tracers [18 F]fluoro-2-deoxy-D-glucose ([18 F]FDG) and 2'-methoxyphenyl-(N-2'-pyridinyl)-p-18 F-fluoro-benzamidoethylpiperazine ([18 F]MPPF) to explore potential biomarkers for neurobehavioral comorbidities in an electrically induced post-status epilepticus rat model of epilepsy. RESULTS In rats with epilepsy, μPET analysis revealed a local reduction in hippocampal [18 F]FDG uptake, and a local increase in [18 F]MPPF binding. These changes exhibited a correlation with burrowing as a "luxury" behavior, social interaction, and anxiety-associated behavioral patterns. Interestingly, hippocampal [18 F]FDG uptake did not correlate with spontaneous recurrent seizure activity. SIGNIFICANCE In the electrically induced post-status epilepticus rat model, we demonstrated hippocampal hypometabolism and its correlation with a range of neurobehavioral alterations. These findings require further confirmation in other preclinical models and patients with epilepsy and psychiatric disorders to address the value of [18 F]FDG uptake as an imaging biomarker candidate for psychiatric comorbidities in patients as well as for severity assessment in rodent epilepsy models.
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Affiliation(s)
- R Maarten van Dijk
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Valentina Di Liberto
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany.,Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ann Marie Waldron
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christina Möller
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Franz Josef Gildehaus
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Barbara von Ungern-Sternberg
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Magdalena Lindner
- German Center for Vertigo and Balance Disorders, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sibylle Ziegler
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Rainer Hellweg
- Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Peter Gass
- Central Institute of Mental Health Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany
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Kehyayan V, Hirdes JP. Care Needs and Health Care Burden of Persons With Epilepsy Receiving Home Care Services. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318806291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The purpose of this study was to describe the characteristics of persons with epilepsy (PWE) receiving home care services. A cross-sectional study was conducted comparing the characteristics of PWE with those without epilepsy (comparison group). PWE were more likely to have mental health issues and functional, mobility, and cognitive impairments; to receive a variety of psychotropic medications; to experience psychosocial issues such as isolation and conflicts in their relationships; to have caregivers experiencing psychological distress; and to be economically disadvantaged necessitating making economic trade-offs in their care. Epilepsy is associated with caregiver distress and has an impact on health resource utilization. Future studies are needed to identify strategies to improve the quality of care and life of PWE.
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