Perceptions of illness severity in adults with drug-resistant temporal lobe epilepsy

Knowledge, attitude and perception of epilepsy patients toward epilepsy surgery at Jordan University hospital

INTRODUCTION

Epilepsy is a condition associated with stigma and considerable morbidity, placing a significant burden on patients and their families. It is fundamental to be mindful of the fact that a substantial number of patients remain unaware of the effective surgical procedures that have shown great success in many cases, drawing upon the global underutilization of epilepsy surgery (ES). In this study, we explore the knowledge and attitudes of epilepsy patients towards ES at Jordan University Hospital (JUH).

AIM

This study aims to evaluate epilepsy patients' attitudes and knowledge regarding ES at JUH, identify the variables affecting their attitudes, and compare the results with other Middle Eastern and Western reports.

METHODS

In this cross-sectional study, conducted between the 1st of March and the 1st of September 2023, we gathered and analyzed data from epilepsy patients in the neurology clinic at JUH. A self-administered questionnaire was utilized, with questions emphasizing patients' demographics, disease status, and their knowledge and attitude toward ES. In order to determine the predictors of attitude, logistic regression was performed on the univariate analysis using the SPSS software.

RESULTS

This study included 145 participants, most of them within the 17 and 29 age group, and a mean age at first seizure of 21.6 years. Our sample included more generalized than focal epilepsy patients, with an additional 30 % of patients being unaware of their specific seizure type. 46 % of patients were on at least 2 antiepileptic drugs (AEDs), especially among the focal epilepsy group and 61 % were non-adherent to their medications. Eighty-two participants (57 %) were aware of ES, yet only twenty-five have shown a high level of understanding. The majority of patients (77 %) have expressed a positive attitude towards ES. Although patients' attitude was significantly associated with their first impression towards ES, age, age at first seizure and not possessing a driving license, the regression model did not reveal significant predictors. Despite the perception of 94 % of the patients that ES has a moderate to high risk, this did not have any significant influence on their final attitude. Furthermore, our results concluded that income, insurance type, educational level, frequency of seizures, and poor academic outcome played no significant role in patients' final attitude towards ES.

CONCLUSION

ES is no longer considered an "experimental" or "last resort" treatment option. The results emphasize the importance of adapting educational interventions to improve knowledge and understanding of ES and implement measures to surgically pre-evaluate potential candidates. Further research should be done to overcome and address this gap in underutilization. In our study, we conclude that this gap is still present especially in people who are in need and may potentially be candidates for ES, but with the displayed positive attitude in the majority of our patients we are optimistic that the remaining barriers can be overcome, and that the results obtained from our study will be helpful for positive advancements in patients' quality of life.

Factors affecting patient activation among patients with systemic lupus erythematosus

There are limited published studies on patient activation among patients with systemic lupus erythematosus (SLE) in China. Disease activity can significantly influence a patient's perception of their condition, subsequently impacting patient activation. However, the mechanisms through which disease activity influences patient activation remain poorly understood. This study aimed to investigate patient activation among patients with SLE in China and explore the influencing factors. We conducted a cross-sectional study from June to December 2021 at a rheumatology and immunology department of a tertiary hospital in Chengdu, China. Data were collected by questionnaire, including general information, disease activity, quality of chronic illness care, health literacy, self-efficacy, motivation, social support, and patient activation. A patient activation model was constructed based on the conceptual framework derived from the individual and family self-management theory. To evaluate the moderating effect of disease activity on patient activation model, participants were divided into two subgroups (low disease activity group and high disease activity group). 426 SLE patients were included. The mean score of patient activation among SLE patients was 63.28 ± 11.82, indicating that most SLE patients lacked skills and confidence to stick with health-promoting behaviors. Health literacy, social support, and self-efficacy had the greatest effect on patient activation. In the multi-group analysis, social support and health literacy contributed more to patient activation in SLE patients with high and low disease activity, respectively. Patient activation among SLE patients in China was at the third level. Healthcare professionals should help them adhere to health-promoting behaviors. Health literacy, social support, and self-efficacy are vital factors for patient activation. These factors should be prioritized based on disease activity when developing individually tailored interventions for patient activation.

Individuals' invisible work continues after epilepsy surgery: A qualitative interview study

OBJECTIVE

How do persons with epilepsy (PWE) experience their everyday lives after epilepsy surgery?

METHODS

Qualitative thematic interviews were conducted with eight PWEs (30 to 60 years old). They were recruited when coming for post-operative control 1 to 5 years after epilepsy surgery. The interviews were transcribed. They were analysed by thematic analysis and inspired by Goffman who examines everyday life activities as a theatre play.

RESULTS

Before surgery, a substantial invisible and hidden work of adjustments was performed to prevent seizures, to secure help from others if seizures occurred, and to protect oneself from others' gaze during a seizure. This invisible work continued after surgery even for those who became seizure-free; but now for the purpose of protecting oneself from relapse of epilepsy. From the participants perspective there was no or minor change in daily activities among those not becoming seizure-free after surgery. In contrast, those who became seizure-free enjoyed the freedom to participate in social activities without planning or restrictions.

CONCLUSIONS

A striking finding was that daily life after surgery comprises considerably invisible work to protect a social self, and this preventive and protective invisible work continued, although those who became seizure-free were living an ordinary socially healthy life.

Epilepsy in Neurodegenerative Diseases: Related Drugs and Molecular Pathways

Epilepsy is a chronic disease of the central nervous system characterized by an electrical imbalance in neurons. It is the second most prevalent neurological disease, with 50 million people affected around the world, and 30% of all epilepsies do not respond to available treatments. Currently, the main hypothesis about the molecular processes that trigger epileptic seizures and promote the neurotoxic effects that lead to cell death focuses on the exacerbation of the glutamate pathway and the massive influx of Ca2+ into neurons by different factors. However, other mechanisms have been proposed, and most of them have also been described in other neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, Huntington's disease, or multiple sclerosis. Interestingly, and mainly because of these common molecular links and the lack of effective treatments for these diseases, some antiseizure drugs have been investigated to evaluate their therapeutic potential in these pathologies. Therefore, in this review, we thoroughly investigate the common molecular pathways between epilepsy and the major neurodegenerative diseases, examine the incidence of epilepsy in these populations, and explore the use of current and innovative antiseizure drugs in the treatment of refractory epilepsy and other neurodegenerative diseases.

Anesthesia considerations for patients with epilepsy: Findings of a qualitative study in the Palestinian practice

OBJECTIVE

This qualitative exploratory study was conducted to explore how anesthesiologists in Palestine provide perioperative care for patients with epilepsy and how they account for the unique challenges relevant to epilepsy while planning perioperative care for patients with epilepsy.

METHODS

This study was conducted in an explorative qualitative design. Purposive and snowball sampling approaches were used to recruit the study participants. Qualitative semi-structured in-depth interviews were conducted with anesthesiologists (n = 10) and a neurologist (n = 1). The qualitative data collected in this study were thematically analyzed using the interpretive description methodology to generate themes, subthemes, and patterns.

RESULTS

Three major themes emerged from the collected qualitative data with a total of 18 subthemes. The 3 themes were: 1) considerations/challenges while assessing patients, 2) anesthetic considerations, and 3) recovery considerations. Lack of epilepsy-specific assessment and anesthesia protocols, underuse of neurology referral services, and lack of neuromonitoring were identified.

CONCLUSION

Findings of this study highlighted the need to develop specific anesthesia protocols for patients with epilepsy. Anesthesiologists and planners of perioperative care should improve collection of patient information and assessment methods, ensure control over seizures, reduce triggers of seizures, and improve patient monitoring approaches. Findings of this study might be used to inform anesthesiologists and decision makers in professional groups, patient advocacy groups, and healthcare authorities to benchmark and improve anesthesia care and services offered to patients with epilepsy. More studies are still needed to quantitatively assess the quality of anesthesia care and services provided to patients with epilepsy.

Reciprocal burden: Adults with drug-resistant epilepsy reflect upon informal caregiver support

PURPOSE

To explore how a sample of people with uncontrolled seizures describe their experiences of receiving informal supportive care.

METHODS

Using constructivist grounded theory, in-person, semi-structured interviews were conducted in 35 adults with drug-resistant epilepsy. These 20 (57%) women and 15 (43%) men were aged 18-68 years (mean= 35.6 years), with a range of verbal comprehension scores. The majority, 28 (80%) lived in nuclear family settings.

RESULTS

Unpredictable seizures disrupted personal autonomy and generated unique challenges for everyday life. While supportive care was deemed necessary to survival, subjective reflections around the implications of care-receiving and caregiving, were ultimately experienced as mutually burdensome. Four dynamic and interactive dimensions revealed a mirrored, interactive perspective of what it meant to be a care-recipient: assuming responsibility; protecting and supervising; acknowledging reliance and setting boundaries. Care-recipience was not one-sided, but included actively hiding personal struggles as a way to shield the caregiver from the emotional and physical demands of caregiving. Relationship dynamics between caregivers and care-recipients played a major role in treatment decision-making. A clinically useful Theory of Reciprocal Burden resulted from our study.

CONCLUSIONS

This study adds an explanatory dimension to the concept of illness burden from the perspective of care-recipients. Relationship dynamics play a key role in patient-centered epilepsy care, with clinical implications for guiding supportive caregiving, fostering independence and promoting self-management strategies.