Socio-economic impact on epilepsy outside of the nation-wide COVID-19 pandemic area

The study of mental health status of people with epilepsy during the COVID-19 pandemic: A systematic review and meta-analysis study

INTRODUCTION

The COVID-19 pandemic has affected the lives of people with epilepsy (PWE) in various ways. This systematic review and meta-analysis aims to assess the mental health status and prevalence of mental disorders including depression, anxiety, stress, and psychological distress among PWE. Furthermore, this study evaluates changes in sleep patterns and presence of sleep disturbances among them. The findings of this systematic review can help health organizations, policymakers, and health workers to better prepare and respond to future health crises for PWE and other chronic disease patients.

METHOD

This systematic review was prepared using PRISMA reporting guidelines. We systematically searched PubMed, Web of Science, Scopus and Cochrane Library databases for studies that reported data on mental health parameters including depression, anxiety, stress, psychological distress, quality of life, and sleep quality, during the pandemic until May 2023. The analytical procedures were executed through the utilization of Comprehensive Meta-Analysis (CMA) software.

RESULTS

In our study, a total of 61 carefully selected studies were analyzed, yielding valuable insights into the prevalence and impact of various mental health indicators among PWE. The findings revealed that a significant proportion of PWE experienced distressing psychological symptoms, with depression being reported by 34% of participants. Additionally, anxiety was prevalent among 43% of individuals, while stress symptoms were reported by 49% of respondents. Moreover, a substantial portion of PWE, approximately 38%, reported experiencing poor sleep quality, further underscoring the multifaceted nature of the challenges faced by this population. These findings highlight the need for targeted interventions and comprehensive support systems to address the mental health concerns and sleep disturbances faced by individuals living with epilepsy.

CONCLUSION

The findings revealed that a substantial number of PWE experience symptoms of depression, anxiety, stress, and poor sleep quality. These results emphasize the importance of considering mental health and sleep assessments as integral components of care for individuals with epilepsy. The study underscores the need for further research and targeted interventions to address the mental health burden faced by this population. By prioritizing and addressing these challenges, healthcare providers can enhance the overall well-being and quality of life for individuals living with epilepsy.

Difficult lives: A descriptive and relational study on the coping with stress and care burden of caregivers of patients with epilepsy

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.

Seizure control during the COVID-19 pandemic: Correlating Responsive Neurostimulation System data with patient reports

Objective

To understand the impact of the Coronavirus Disease-2019 (COVID-19) pandemic on seizure frequency in persons with epilepsy with a Responsive Neurostimulation (RNS) system implanted.

Methods

Weekly long episode counts (LEC) were used as a proxy for seizures for six months pre-COVID-19 and during the COVID-19 period. Telephone surveys and chart reviews were conducted to assess patient mental health during the pandemic. The change in LEC between the two time periods was correlated to reported stressors.

Results

Twenty patients were included. Comparing the pre-COVID-19 period to the COVID-19 period, we found that only 5 (25%) patients had increased seizures, which was positively correlated with change in anti-seizure medications (ASM, p = 0.03) and bitemporal seizures (p = 0.03). Increased seizures were not correlated to anxiety (p = 1.00), depression (p = 0.58), and sleep disturbances (p = 1.00). The correlation between RNS-detected and patient-reported seizures was poor (p = 0.32).

Conclusions

Most of our patients did not have an increase in seizures following the COVID-19 pandemic. Changes in ASM and bitemporal seizures were positively correlated to increased LEC. There was no correlation between pandemic-related stress and seizures in those found to have increased seizures.

Significance

This is the first study correlating RNS-derived objective LECs with patient self-reports and potential seizure risk factors during the COVID-19 pandemic.

Social Isolation and Associated Factors in Chinese Adults With Epilepsy: A Cross-Sectional Study

Objective: We aimed to determine the prevalence of social isolation and associated factors among adults with epilepsy in northeast China. Methods: A cohort of consecutive patients with epilepsy (PWE) from the First Hospital of Jilin University (Changchun, China) was recruited. Demographic and clinical data for each patient were collected during a face-to-face interview. Social isolation was measured using the Berkman-Syme Social Network Index (SNI), and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Quality of Life in Epilepsy Inventory (QOLIE-31) were also administered. Multivariate logistic regression analyses were used to determine the factors associated with social isolation in PWE. Results: A total of 165 patients were included in the final analysis. The mean SNI score was 2.56 (SD: 1.19), and 35 patients (21.2%) were socially isolated. In multivariate logistic regression analysis, higher depressive symptom levels (OR = 1.15, 95% CI: 1.003-1.318, P = 0.045) and poorer quality of life (OR = 0.967, 95% CI: 0.935-0.999, P = 0.047) emerged as independent factors associated with social isolation in PWE. Conclusion: Social isolation is common and occurs in approximately one-fifth of PWE. Social isolation is significantly associated with depressive symptoms and poor quality of life in PWE. Patients need to be encouraged to actively integrate with others and reduce social isolation, which may help improve their quality of life.

A longitudinal seizure outcome following the COVID-19 pandemic in 2020 and 2021: Transient exacerbation or sustainable mitigation

Objective

To study the longitudinal seizure outcomes of people with epilepsy (PWE) following the acute and chronic phases of the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Consecutive PWE who were treated at the epilepsy center of Hiroshima University Hospital between 2018 and 2021 were enrolled. We evaluated the incidence of seizure frequency increase or decrease following the pandemic during observational periods in 2020 and 2021. Data between 2018 and 2019 were used as a control set. The sustainability of the altered seizure frequency condition was evaluated throughout the study period. We analyzed the clinical, psychological, and social factors associated with PWE with seizure exacerbation or amelioration.

Results

Among the 223 PWE who were evaluated (mean age 37.8 ± 16.3 years), seizure frequency increased for 40 (16.8%) and decreased for 34 (15.2%) after the pandemic began. While seizure exacerbation tended to be a transient episode during 2020, seizure amelioration was likely to maintain excellent status over the observation periods; the sustainability of the altered seizure frequency condition was more prominent for amelioration than exacerbation (p < 0.001). Seizure exacerbation was significantly associated with “no housemate” (odds ratio [OR] 3.37; p = 0.045) and “comorbidity of insomnia” (OR 5.80; p = 0.004). Conversely, “structural abnormality of MRI” (OR 2.57; p = 0.039) and “two-generation householding” (OR 3.70; p = 0.004) were independently associated with seizure amelioration.

Conclusion

This longitudinal observation confirmed that seizure exacerbation and amelioration emerged during the COVID-19 pandemic. The COVID-19 pandemic has shed light on the stark difference that social support systems can make on outcomes for PWE.

The impact of social factors, especially psychological worries on anxiety and depression in patients with epilepsy

BACKGROUND

Social factors are believed to affect mental health in patients with epilepsy (PWE). However, there is still a lack of sufficient manifest proof, given the difficulty of exposing PWE to relatively consistent natural social environments with a low or high level of social interaction to study their significant role.

METHODS

This single-center, longitudinal study was conducted via online questionnaires during the coronavirus disease 2019. PWE were recruited from downtown Wuhan and surrounding areas. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 were used to assess psychological status.

RESULTS

We analyzed 588 questionnaires completed by 294 PWE who participated in the dual survey. Under lockdown and reopening, the prevalence of anxiety was 13.6%/22.5%, and the prevalence of depression was 19.4%/34.0%. Raising children and seizure-related characteristics, including uncontrolled seizures, seizure exacerbation, seizure frequency ≥ 2/m, and changes in drug regimen, were risk factors in the first and second surveys. A high education level (OR = 1.946, 95% CI = 1.191-3.182), low life satisfaction (OR = 1.940, 95% CI = 1.007-3.737), worry about unanticipated seizures (OR = 2.147, 95% CI = 1.049-4.309), and worry about purchasing medication outside (OR = 2.063, 95% CI = 1.060-4.016) were risk factors for higher scores after reopening. Worry about unanticipated seizures (OR = 3.012, 95% CI = 1.302-6.965) and in-person medical consultation (OR = 2.319, 95% CI = 1.262-4.261) were related to newly diagnosed patients with psychological disorder after reopening.

CONCLUSIONS

We identified an association between social variables and epileptic psychiatric comorbidities.

Risk factors for psychological distress in electroencephalography technicians during the COVID-19 pandemic: A national-level cross-sectional survey in Japan

OBJECTIVE

To identify the risk factors for psychological distress in electroencephalography (EEG) technicians during the coronavirus disease 2019 (COVID-19) pandemic.

METHOD

In this national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan), which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES), a questionnaire was administered to 173 technicians engaged in EEG at four clinics specializing in epilepsy care and 20 hospitals accredited as (quasi-) epilepsy centers or epilepsy training facilities in Japan from March 1 to April 30, 2021. We collected data on participants' profiles, information about work, and psychological distress outcome measurements, such as the K-6 and Tokyo Metropolitan Distress Scale for Pandemic (TMDP). Linear regression analysis was used to identify the risk factors for psychological distress. Factors that were significantly associated with psychological distress in the univariate analysis were subjected to multivariate analysis.

RESULTS

Among the 142 respondents (response rate: 82%), 128 were included in the final analysis. As many as 35.2% of EEG technicians have been under psychological distress. In multivariate linear regression analysis for K-6, female sex, examination for patients (suspected) with COVID-19, and change in salary or bonus were independent associated factors for psychological distress. Contrastingly, in multivariate linear regression analysis for TMDP, female sex, presence of cohabitants who had to be separated from the respondent due to this pandemic, and change in salary or bonus were independent associated factors for psychological distress.

CONCLUSION

We successfully identified the risk factors associated with psychological distress in EEG technicians during the COVID-19 pandemic. Our results may help in understanding the psychological stress in EEG technicians during the COVID-19 pandemic and improving the work environment, which is necessary to maintain the mental health of EEG technicians.