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Muralidharan P, Sankaran R, Bendapudi P, Kumar CS, Kumar AA. AI in ECG: Validating an ambulatory semiology labeller and predictor. Epilepsy Res 2024; 204:107403. [PMID: 38944916 DOI: 10.1016/j.eplepsyres.2024.107403] [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: 04/17/2024] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Early prediction of epileptic seizures can help reduce morbidity and mortality. In this work, we explore using electrocardiographic (ECG) signal as input to a seizure prediction system and note that the performance can be improved by using selected signal processing techniques. METHODS We used frequency domain analysis with a deep neural network backend for all our experiments in this work. We further analysed the effect of the proposed system for different seizure semiologies and prediction horizons. We explored refining the signal using signal processing to enhance the system's performance. RESULTS Our final system using the Temple University Hospital's Seizure (TUHSZ) corpus gave an overall prediction accuracy of 84.02 %, sensitivity of 87.59 %, specificity of 81.9 %, and an area under the receiver operating characteristic curve (AUROC) of 0.9112. Notably, these results surpassed the state-of-the-art outcomes reported using the TUHSZ database; all findings are statistically significant. We also validated our study using the Siena scalp EEG database. Using the frequency domain data, our baseline system gave a performance of 75.17 %, 79.17 %, 70.04 % and 0.82 for prediction accuracy, sensitivity, specificity and AUROC, respectively. After selecting the optimal frequency band of 0.8-15 Hz, we obtained a performance of 80.49 %, 89.51 %, 75.23 % and 0.89 for prediction accuracy, sensitivity, specificity and AUROC, respectively which is an improvement of 5.32 %, 10.34 %, 5.19 % and 0.08 for prediction accuracy, sensitivity, specificity and AUROC, respectively. CONCLUSIONS The seizure information in ECG is concentrated in a narrow frequency band. Identifying and selecting that band can help improve the performance of seizure detection and prediction. SIGNIFICANCE EEG is susceptible to artefacts and is not preferred in a low-cost ambulatory device. ECG can be used in wearable devices (like chest bands) and is feasible for developing a low-cost ambulatory device for seizure prediction. Early seizure prediction can provide patients and clinicians with the required alert to take necessary precautions and prevent a fatality, significantly improving the patient's quality of life.
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Affiliation(s)
- Pooja Muralidharan
- Machine Intelligence Research Laboratory, Department of Electronics and Communication Engineering, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu 641112, India
| | - Ravi Sankaran
- Department of Physical Medicine and Rehabilitation, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, Kerala 682041, India
| | - Perraju Bendapudi
- Department of Neonatology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, Kerala 682041, India
| | - C Santhosh Kumar
- Machine Intelligence Research Laboratory, Department of Electronics and Communication Engineering, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu 641112, India.
| | - A Anand Kumar
- Department of Neurology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, Kerala 682041, India
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Stotaw AS, Kumar P, Beyene DA, Tadesse TA, Abiye AA. Health-related quality of life and its predictors among people living with epilepsy at Dessie Referral Hospital, Amhara, Ethiopia: A cross-sectional study. SAGE Open Med 2022; 10:20503121221129146. [PMID: 36246536 PMCID: PMC9558868 DOI: 10.1177/20503121221129146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Health-related quality of life of people living with epilepsy is significantly impaired. The disease causes a significant psychological and social impact on daily living conditions and usually has lifelong consequences for the patient and family. Therefore, this study aimed to investigate the health-related quality of life of people living with epilepsy and its predictors in Dessie Referral Hospital, Dessie, Ethiopia. METHODS A facility-based cross-sectional study was conducted from April to June 2020. Systematic random sampling was used to recruit a total of 385 study participants. Written informed consent was obtained for each participant, and data were collected using World Health Organization Quality of Life Brief Version and Hospital Anxiety and Depression Scale questionnaires. Descriptive statistics were used to summarize the data, while multivariate logistic regression analyses were used to examine factors affecting the quality of life. P value ⩽ 0.05 was considered statistically significant. RESULTS About 95.80% of the study participants had a generalized seizure, and 64.30% were on two antiepileptic drugs. Of the total, 12.20% and 37.00% suffered from depression and anxiety, respectively, based on the Hospital Anxiety and Depression Scale score. The mean total health-related quality of life score was 51.98 (standard deviation: ± 10.08; 95% confidence interval: 41.90-62.06) out of 100. Age, education level, marital status, occupation, residence, current comorbidity, family support, and recreational activities were associated with good health-related quality of life (p ⩽ 0.05). CONCLUSION The average overall quality of life of people living with epilepsy in the Dessie Referral Hospital was low. Therefore, concerted efforts must be made to improve the quality of life of patients over the healthcare services provided.
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Affiliation(s)
- Alebachew Sisay Stotaw
- Department of Adult Health Nursing,
School of Midwifery and Nursing, College of Medicine and Health Sciences, Wollo
University, Dessie, Ethiopia
| | - Prem Kumar
- Department of Adult Health Nursing,
School of Midwifery and Nursing, College of Medicine and Health Sciences, Wollo
University, Dessie, Ethiopia
| | - Dessale Abate Beyene
- Clinical Pharmacy Unit, Department of
Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Addis
Ababa, Africa, Ethiopia
| | - Tamrat Assefa Tadesse
- Department of Pharmacology and Clinical
Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University,
Addis Ababa, Ethiopia
| | - Alfoalem Araba Abiye
- Department of Pharmacology and Clinical
Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University,
Addis Ababa, Ethiopia,Alfoalem Araba Abiye, Department of
Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health
Sciences, Addis Ababa University, Addis Ababa 1176, Ethiopia.
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Impact of Clinical and Socio-Demographic Factors on the Quality of Life in Romanian People with Epilepsy. Healthcare (Basel) 2022; 10:healthcare10101909. [PMID: 36292357 PMCID: PMC9602014 DOI: 10.3390/healthcare10101909] [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: 08/20/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
This study investigates the impact of different clinical and demographic factors on the quality of life in people with epilepsy hospitalized at a health institution of Brasov County, Romania, using a QOLIE-31-P questionnaire and to reflect on the opportunities and limitations of incorporating such an instrument into the clinical practice. Methods: Ninety-one patients with a diagnosis of epilepsy evaluated by video-electroencephalography in the Clinical Hospital of Psychiatry and Neurology in Brasov, Romania, were recruited. After the confirmation of the diagnosis based on clinical, electrophysiological and imagistic examination, and of their compliance with the hospitalization criteria, the patients filled in the QOLIE-31-P questionnaire. Socio-demographic and clinical data were collected. Results: The seizure frequency was negatively correlated with almost all QOLIE-31-P domains (p < 0.05). Age, employment status, level of education and uncontrolled disease were significant factors associated with a low quality of life. The mean (SD) QOLIE-31-P scores were 64.89 (14.72), the mean age was 43.04 (14.92) years, with the average age of the first seizure onset 30.66 (17.45) years. Conclusion: The use of measuring instruments to assess the quality of life of patients with epilepsy despite the challenges should become a routine practice, the information collected in this way can improve the outcomes in the care of these patients. In addition to the goal of reducing the frequency of seizures, physicians must also take into account other parts of the experiences of people with epilepsy.
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Gilkinson C, Kinney M, Olaniyan T, Murtala B, Sipilon M, Malunga A, Joof SM, Shankar R. Perceptions about mental healthcare for people with epilepsy in Africa. Epilepsy Behav 2022; 127:108504. [PMID: 34954510 DOI: 10.1016/j.yebeh.2021.108504] [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: 10/25/2021] [Revised: 11/27/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mental illness is commonly comorbid with epilepsy. In sub-Saharan Africa there exists limited access to neurological and psychiatric services predisposing to a "treatment gap" in epilepsy and mental healthcare. AIMS To understand healthcare providers' knowledge, attitudes, and management practices toward epilepsy and comorbid mental illness in sub-Saharan Africa. METHODS A cross-sectional online survey following the STROBE guidance was conducted among healthcare providers in sub-Saharan Africa. Eleven questions looking to ascertain clinician demographics, knowledge of epilepsy, and comorbid mental illness as well as management practices were developed. FINDINGS Of 203 responses most (92%) respondents recognized a bi-directional relationship between mental health and epilepsy. However, mental illness screening in people newly diagnosed with epilepsy was infrequently performed (14%). Only 1 in 7 (16%) respondents had high confidence in their clinical competence at managing psychiatric comorbidities. Most would value further training (74%) and improvements to be made in current management practices within their local healthcare settings (94%). CONCLUSIONS This pilot study highlights the need to improve the awareness of management of mental disorders in populations with epilepsy within sub-Saharan Africa in health providers there.
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Affiliation(s)
- Chloe Gilkinson
- Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Michael Kinney
- Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK; Belfast Health and Social Care Trust, UK
| | - Tolu Olaniyan
- Pretola Global Health Consulting Limited, Isle Of Wight, UK
| | - Bankole Murtala
- Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | | | | | - Sohna M Joof
- Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - Rohit Shankar
- University of Plymouth, Peninsula School of Medicine, Truro, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK.
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Willems LM, Knake S, Rosenow F, Reese JP, Conradi N, Strzelczyk A. EuroQOL-5D-3L does not adequately map quality-of-life deterioration in severely affected patients with epilepsy. Epilepsy Behav 2022; 127:108554. [PMID: 35063789 DOI: 10.1016/j.yebeh.2022.108554] [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: 12/07/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The steadily increasing impact of health-related quality of life (HRQOL) on reasonable diagnostic and therapeutic decisions makes the correct mapping of HRQOL indispensable in modern epileptology. The aim of this study was to address the reliability of the often-used generic HRQOL screening questionnaire EuroQOL 5-dimension, 3-level (EQ-5D-3L) by comparing its normalized index value (calculated via the time trade-off method) and visual analog scale (VAS) to the gold standard of the extensive Quality of Life in Epilepsy Inventory (QOLIE-31). QOLIE-10 scores were compared with the extensive QOLIE-31 and EQ-5D-3L TTO. METHODS We conducted a retrospective analysis of a monocentric study of 184 patients with epilepsy. Bivariate Spearman correlation analysis and Fisher's r-to-z transformation were used to compare the strengths of correlations of EQ-5D-3L, QOLIE-10 and QOLIE-31 with different epilepsy-specific domains (disease severity, drug interactions, emotional well-being, stigmatization, seizure-related anxiety, cognitive impairment). RESULTS The different metrics of EQ-5D-3L, QOLIE-10 and QOLIE-31 showed moderate to very strong intra- and inter-metric correlations for overall HRQOL. Quality of Life in Epilepsy Inventory-31 VAS and EQ-5D-3L VAS did not show any significantly different strengths of correlations with respect to the domains studied. In contrast, the correlation strength of the normalized EQ-5D-3L index value differed significantly from the QOLIE-31 T-score for several domains, for example, for drug-related adverse events, neuropsychological deficits, symptoms of depression and seizure worry. In seizure-free patients, EQ-5D-3L VAS and EQ-5D-3L index values correlated significantly less with the domain of "cognitive impairment" than the QOLIE-31 T-score. In patients without relevant neuropsychological deficits, the strengths of correlations with the assessed domains did not differ significantly between EQ-5D-3L metrics and the QOLIE-31 T-score. The HRQOL mapping probability of QOLIE-10 was inferior to QOLIE-31 and comparable to EQ-5D-3L regarding the analyzed domains. CONCLUSION In contrast to the EQ-5D-3L VAS, EQ-5D-3L index values do not adequately map health-related quality of life in severely affected patients with epilepsy and therefore should not be used as screening tools. The QOLIE-31 T-score remains the gold standard for HRQOL assessment in patients with epilepsy.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Susanne Knake
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Germany
| | - Nadine Conradi
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
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Mroueh L, Boumediene F, Jost J, Ratsimbazafy V, Preux PM, Salameh P, Al-Hajje A. Quality of life and stigma in Lebanese people with epilepsy taking medication. Epilepsy Res 2020; 167:106437. [DOI: 10.1016/j.eplepsyres.2020.106437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/07/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022]
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Ogundare T, Adebowale TO, Okonkwo OA. Quality of life among patients with epilepsy in Nigeria: predictors and barriers to routine clinical use of QOLIE-31. Qual Life Res 2020; 30:487-496. [PMID: 32959121 DOI: 10.1007/s11136-020-02643-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the factors predicting poorer quality of life (QOL) among patients with epilepsy attending an out-patient clinic in a Nigerian tertiary hospital, and reflect on the barriers to successful adoption of a structured QOL instrument into routine clinical practice. METHODS Two-hundred and seventy patients with a diagnosis of epilepsy attending the Neuropsychiatric Hospital, Abeokuta, Nigeria were recruited. Sociodemographic and clinical information were collected using a proforma. QOLIE-31 was administered to measure QOL. RESULTS The mean (SD) QOLIE-31 scores were 77.98 (13.32), with 15.2%, 74.1%, and 10.7% of the respondents classified as low, moderate, and high QOL, respectively. Factors associated with poorer QOL include seizure frequency, depression, and family history of epilepsy. CONCLUSION Quality of life is an important outcome measure for people with epilepsy and it focuses on the individual's subjective assessment of their well-being. Although useful for clinical management of patients with epilepsy, the uniqueness of the practice settings and the limitations of clinical practice in a developing country pose challenges to successful adoption of structured QOL instrument into routine clinical practice.
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Affiliation(s)
- Temitope Ogundare
- Neuropsychiatric Hospital Aro, Abeokuta, Ogun State, Nigeria. .,Boston University School of Public Health, Boston, MA, 02118, USA.
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Abadiga M, Mosisa G, Amente T, Oluma A. Health-related quality of life and associated factors among epileptic patients on treatment follow up at public hospitals of Wollega zones, Ethiopia, 2018. BMC Res Notes 2019; 12:679. [PMID: 31640789 PMCID: PMC6805515 DOI: 10.1186/s13104-019-4720-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/12/2019] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to assess health-related quality of life and its associated factors among epileptic patients in public hospitals of Wollega zones, Ethiopia. Institutional based cross-sectional study was conducted on 402 epileptic patients, from March 01 to March 30, 2018. Multiple linear regression with backward elimination was used, and all analyses were conducted at the 0.05 significance level. Results The overall mean total score on the WHOQOL-BREF scale was 60.47 with ± 23.07 SD. Monthly income ≤ 500 EB (β = − 12.49, P < 0.001), living alone (β = − 7.11, P = 0.007), adverse drug reaction (β = − 10.86, P < 0.001), comorbidity of anxiety (β = − 12.99, P < 0.001), perceived social stigma (β = − 9.73, P < 0.001) and frequency of seizure once per week (β = − 8.41, P = 0.001) were negatively associated with quality of life of epileptic patients. The mean quality of life of patients living with epilepsy in this study was low. The clinician should early recognize and treat drug side effects, detect and manage comorbidity, and control seizure in order to increase quality of life of epileptic patients.
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Affiliation(s)
- Muktar Abadiga
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Getu Mosisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadele Amente
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adugna Oluma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Kuzmanova R, Stefanova I, Stambolieva K. Significance of noncompliance when treating patients with epilepsy. Neurol Neurochir Pol 2017; 52:215-221. [PMID: 29096920 DOI: 10.1016/j.pjnns.2017.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 09/19/2017] [Accepted: 10/13/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The absence of patient's cooperation when it comes to his/her treatment ("noncompliance") is typical to chronic diseases and it is significant problem in medical practice. The term "compliance" means patient's capability of strictly adhering to the recommendations concerning the prescribed treatment. The noncompliance with drug regime is frequent case in patients with epilepsy, it is related to increased risk of epileptic seizures' occurrence and other undesired consequences, including increased costs in the healthcare area. OBJECTIVE The objective of our research is assessing the interconnection between compliance with the treatment and social-demographic and clinical factors in patients with epilepsy. CONTINGENT AND METHODS The research covers 131 consecutively included patients with epilepsy of various social-demographic and clinical characteristics. We have utilized analysis of the medical documentation, anamnesis, study of the somatic and neurological status, self-assessment scales and statistical methods. RESULTS We established statistically significant positive correlations between the number of patients with poor compliance and the absence of professional/educational occupation, frequency of epileptic seizures, number of the antiepileptic drugs taken during the present and past treatment, the simultaneous presence of poor control of epileptic seizures and adverse drug events being the reason behind the modification of the previous treatment. CONCLUSION Patient's poor compliance, the great frequency of seizures, the higher number of antiepileptic drugs and the adverse drug reactions have negative impact on the course of the epileptic disease. The improved compliance results in optimizing the antiepileptic treatment, improving patients' condition and significantly cutting down costs incurred in the healthcare area.
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Affiliation(s)
- Rumyana Kuzmanova
- University Hospital of Neurology and Psychiatry "St. Naum", Louben Russev str. 1, 1113 Sofia, Bulgaria; Medical University, Akad. Ivan Evstratiev Geshov Boul. 15, 1431 Sofia, Bulgaria.
| | - Irina Stefanova
- University Hospital of Neurology and Psychiatry "St. Naum", Louben Russev str. 1, 1113 Sofia, Bulgaria.
| | - Katerina Stambolieva
- Institute of Neurobiology, Bulgarian Academy of Science, Acad. Georgi Bonchev 23, 1113 Sofia, Bulgaria.
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Mehmood S, Dale C, Parry M, Snead C, Valiante TA. Predictive coding: A contemporary view on the burden of normality and forced normalization in individuals undergoing epilepsy surgery. Epilepsy Behav 2017; 75:110-113. [PMID: 28843211 DOI: 10.1016/j.yebeh.2017.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/22/2017] [Accepted: 06/11/2017] [Indexed: 12/21/2022]
Abstract
Following epilepsy surgery, a good psychosocial outcome is not necessarily contingent on a good seizure outcome. Increasingly, it is believed that "successful" surgery is a combination of both an acceptable and expected seizure status as well as the individual's perception of improvements in quality of life (QOL). The factors that create this optimal outcome remain an ongoing area of research in the epilepsy community. That being said, there have been some major breakthroughs in observing and understanding poor outcomes seen in a subset of postoperative patients with epilepsy. Characteristics of burden of normality and forced normalization are two phenomena that have been evident in cases of poor postoperative outcomes. In this review, we provide a summary of research and concepts used to explain these poor QOL outcomes for a seemingly successful surgery and suggest a contemporary view in understanding the mechanism of forced normalization through understanding the brain as a predictive organ. Using such a predictive coding model together with recommendations of other studies, we suggest the crucial need for a preoperative intervention addressing patient predictions and expectations to optimize on the benefits achievable through epilepsy surgery.
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Affiliation(s)
- Sumayya Mehmood
- Krembil Research Institute, Toronto Western Hospital (TWH), Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Carter Snead
- Division of Neurology, Departments of Medicine, Paediatrics and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Taufik A Valiante
- Krembil Research Institute, Toronto Western Hospital (TWH), Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Schraegle WA, Titus JB. The relationship of seizure focus with depression, anxiety, and health-related quality of life in children and adolescents with epilepsy. Epilepsy Behav 2017; 68:115-122. [PMID: 28142130 DOI: 10.1016/j.yebeh.2016.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/30/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
For youth with epilepsy, comorbid psychiatric conditions, such as depression and anxiety, require further examination as they carry increased risk for reduced health-related quality of life (HRQOL). The current study assessed whether rates of depression, anxiety, and withdrawal behaviors differed based on seizure location. Data included parental ratings on the Behavior Assessment System for Children (BASC-2) and the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 132 children and adolescents (mean age=11.34, SD=3.95) with generalized or partial (i.e., frontal [FLE] or temporal lobe epilepsy [TLE]) epilepsy. Our results identified clinically significant internalizing psychopathology in nearly half of our sample (41%). Although rates of internalizing behavior were similar between generalized and partial groups, children and adolescents with TLE demonstrated higher rates of depression compared to youth with FLE. No effects of laterality on internalizing behaviors were identified between TLE and FLE groups. Finally, for youth with TLE, parental depression ratings along with current number of antiepileptic medications (AEDs) were found to be significant barriers to HRQOL above and beyond anxiety, withdrawal, and epilepsy-specific variables. Temporal lobe epilepsy was associated with a two-fold risk of clinically significant depression ratings. These findings highlight the high prevalence of internalizing psychopathology features in pediatric epilepsy and offer further support for the relationship between depression and TLE in children and adolescents with epilepsy.
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Affiliation(s)
- William A Schraegle
- Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, Austin, TX, USA; Department of Educational Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Jeffrey B Titus
- Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, Austin, TX, USA; Department of Psychology, The University of Texas at Austin, Austin, TX, USA.
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Kalyva E, Melonashi E. Parental Perceptions of Health-Related Quality of Life of Albanian Children with Epilepsy. Health Psychol Res 2015; 3:2244. [PMID: 26973964 PMCID: PMC4768536 DOI: 10.4081/hpr.2015.2244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/23/2022] Open
Abstract
Epilepsy adversely affects the health-related quality of life (HRQoL) of children living with it. Even though almost 80% of children with epilepsy live in developing countries very little research has been conducted with the specific population. The present study took place in Albania and aimed to investigate parental perceptions of the HRQoL of their children with epilepsy. Considering the well-defined gender roles in the Albanian traditional family it was expected that mothers and fathers reports of their children's HRQoL would differ. Results showed no differences in maternal and paternal reports; instead there was a moderate correspondence between the reports across all dimensions. Parents also reported the highest scores of HRQoL in the interpersonal dimension and the lowest scores in the intrapersonal dimension. The findings have implications in the context of future research and also medical care for children with epilepsy in Albania.
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Affiliation(s)
- Efrosini Kalyva
- City College, International Faculty of the University of Sheffield, Thessaloniki, Greece
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Sulimani-Aidan Y, Rimmerman A. Beyond medical diagnosis: Factors contributing to life satisfaction of women with epilepsy in Israel. Epilepsy Behav 2015; 45:110-7. [PMID: 25819945 DOI: 10.1016/j.yebeh.2015.02.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/11/2015] [Accepted: 02/28/2015] [Indexed: 11/25/2022]
Abstract
This study was an exploratory study aimed to examine the contribution of both objective variables (such as education, occupational status, and leisure activity) and subjective variables (such as perceived disability, body image, and feminine self-image) to the life satisfaction of women with epilepsy in Israel. The study also sought to compare the findings with earlier studies of women with epilepsy or other disabilities in order to identify similar patterns in their life satisfaction. The study included 70 women, who had applied in the past to the Israel Epilepsy Association to obtain information and leisure activities. They were asked about their degree of life satisfaction in the context of their personal data including occupational status, leisure activity, perceived disability, body image, and feminine self-image. Findings indicated that higher education and perception of body image and femininity were positively correlated with higher life satisfaction. The regression model showed that perceived severity of disability and body image had the highest contribution to satisfaction with life, a fact that attests to the paramount importance of women's perception of their health disability in dealing with the disorder. These findings are discussed in relation to earlier comparative studies of those with/without epilepsy. The implications for practice suggest aspects that ought to be included in therapeutic interventions such as including contents related to feminine self-image and body image in the rehabilitation process as well as recommendations for future studies.
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Affiliation(s)
- Yafit Sulimani-Aidan
- Chapin Hall at the University of Chicago, School of Social Service Administration, USA.
| | - Arie Rimmerman
- School of Social Work, Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel.
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Ryu HU, Lee SA, Eom S, Kim HD. Perceived stigma in Korean adolescents with epilepsy: Effects of knowledge about epilepsy and maternal perception of stigma. Seizure 2015; 24:38-43. [DOI: 10.1016/j.seizure.2014.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/26/2014] [Accepted: 11/25/2014] [Indexed: 11/24/2022] Open
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Fisher RS, Nune G, Roberts SE, Cramer JA. The Personal Impact of Epilepsy Scale (PIES). Epilepsy Behav 2015; 42:140-6. [PMID: 25450530 DOI: 10.1016/j.yebeh.2014.09.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/21/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The impact of epilepsy is manifest by effects related to seizures and side effects of therapy and comorbidities such as depression. This report describes the development of a brief patient-reported outcome (PRO) instrument, the Personal Impact of Epilepsy Scale (PIES), to measure the influence of epilepsy overall and in each of these domains. METHODS Instrument development followed standard procedures and an FDA Guidance. People with epilepsy were surveyed with open-ended questions to derive major themes of their concerns, resulting in 4 key areas: seizures, side effects, comorbidities, and overall quality of life (QOL). A preliminary set of 152 questions was based on these themes and completed by 50 patients, age 42.7 (range: 21-71) years, concurrent with comparator instruments, including the NH Seizure Severity Scale (NHSSS), the Liverpool Adverse Events Profile (LAEP), the Quality of Life in Epilepsy (QOLIE-31) scale, the Beck Depression Inventory, and the Epilepsy Foundation Depression: A Checklist. A multiple regression model indicated which PIES measures were associated with scores from the comparator instruments. Questions in each of the domains were selected for correlations and nonduplication. Test-retest consistency at a 3-day interval was completed by 38 subjects and a final set of questions constructed. RESULTS The final question set comprised 25 items: 9 about characteristics of seizures, 7 about medication side effects, 8 about comorbidities, and 1 about overall quality of life. All items had 5 response choices (0-4), with higher scores reflecting more negative status. A total of 46 subjects completed the 25 questions. Cronbach's alpha was 0.87, indicating good internal consistency. Each of the three domains correlated well with the overall QOL item. The questions pertaining to seizures correlated with the NHSSS, the side effect questions with the LAEP, and the comorbidity questions with the QOLIE-31. CONCLUSION The PIES provides a simple, brief PRO measure as a profile of overall impact of seizures, medication side effects, comorbidities, and overall QOL for people with epilepsy. Further study will explore sensitivity to change quantification of the minimal clinically significant change.
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Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA USA.
| | - George Nune
- Department of Neurology, Keck USC School of Medicine, Los Angeles, CA, USA
| | - Sanford E Roberts
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Joyce A Cramer
- Yale University School of Medicine, New Haven, CT, USA; Joyce Cramer Consulting, Houston, TX, USA
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Sano F, Kanemura H, Tando T, Goto Y, Hosaka H, Sugita K, Aihara M. Depressive symptoms contribute to quality of life in children with epilepsy. Eur J Paediatr Neurol 2014; 18:774-9. [PMID: 25194686 DOI: 10.1016/j.ejpn.2014.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/30/2014] [Accepted: 08/10/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Improvement of the quality of life (QOL) for children with epilepsy is one of the most important therapeutic goals. It is widely acknowledged that in adults with epilepsy one of the best QOL predictors is psychiatric comorbidity. In children with epilepsy, however, it is not clear whether psychiatric comorbidity impairs QOL. AIMS The aim of this study was to evaluate QOL in children with epilepsy and to identify the strongest predictors of the same. METHODS A total of 28 enrolled patients completed the Questionnaire for Measuring Health-Related Quality of Life in Children (KINDL-R) and 3 assessments of clinical status: the Depression Self-Rating Scale for Children (DSRS-C), the Children Manifest Anxiety Scale (CMAS), and the Side Effects and Life Satisfaction (SEALS). Various demographic and clinical factors were analyzed as possible predictors of KINDL-R scores. RESULTS The strongest predictor of QOL was the total DSRS-C score (r = -0.69, p < 0.01), which also predicted physical (r = -0.58, p < 0.01) and emotional wellbeing (r = -0.53, p < 0.05) subscale scores. CONCLUSIONS Symptoms of depression were more predictive of QOL than were seizure type, seizure duration, number and adverse effects of AEDs, or anxiety. Number of AEDs did have an effect, just not as prominent as symptoms of depression.
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Affiliation(s)
- Fumikazu Sano
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hideaki Kanemura
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
| | - Tomoko Tando
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yusuke Goto
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiromi Hosaka
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kanji Sugita
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masao Aihara
- Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
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Fawale MB, Owolabi MO, Ogunniyi A. Effects of seizure severity and seizure freedom on the health-related quality of life of an African population of people with epilepsy. Epilepsy Behav 2014; 32:9-14. [PMID: 24463302 DOI: 10.1016/j.yebeh.2013.12.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/17/2013] [Accepted: 12/21/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE This study aimed at determining the effects of seizure severity and seizure freedom on health-related quality of life (HRQOL) of people with epilepsy (PWE) in the presence of perceived stigma in a sub-Saharan African culture. METHODS Health-related quality of life was assessed using QOLIE-31 in 93 consecutive adults (56 males and 37 females) with epilepsy. They were stratified into seizure-free, low-moderate seizure severity, and high seizure severity groups based on the seizure type and the number of seizures in the previous 6months. Other illness variables and sociodemographic variables were also obtained. A 3-item perceived stigma scale was administered. A modified QOLIE-31 (excluding the epilepsy-specific items) was given to 102 age- and sex-matched healthy controls. RESULTS There was moderate negative correlation between seizure severity and mean total HRQOL score as well as scores on the Seizure Worry (p=.000), Overall Quality of Life (p=.000), and Social Function (p=.001) subscales of QOLIE-31. Overall, the healthy control subjects had a higher mean HRQOL score compared with the PWE put together (71.0+11.1 vs 64.2±13.6, p=.001). However, there was no difference in the mean HRQOL score between the seizure-free individuals and the healthy controls (p=.270). Seizure severity was associated with HRQOL independent of perceived stigma on a multiple regression analysis. CONCLUSION This study provides evidence that seizure severity relates to health-related quality of life in an inverse, graded manner and independent of perceived stigma. Seizure-free people with epilepsy can have quality of life comparable with healthy individuals.
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Affiliation(s)
- Michael B Fawale
- Neurology Unit, Medicine Department, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Mayowa O Owolabi
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Adesola Ogunniyi
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
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Stafford M, Gavriel S, Lloyd A. Patient-reported outcomes measurements in epilepsy. Expert Rev Pharmacoecon Outcomes Res 2014; 7:373-84. [DOI: 10.1586/14737167.7.4.373] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Piperidou H, Haritomeni P, Terzoudi A, Aikaterini T, Vorvolakos T, Theofanis V, Davis E, Elizabeth D, Heliopoulos I, Ioannis H, Vadikolias K, Konstantinos V, Giassakis G, Georgios G, Aggelopoulos P, Petros A, Georgios G, Karlovasitou A, Anna K. The Greek Version of the Quality of Life in Epilepsy Inventory (QOLIE-31). Qual Life Res 2013; 15:833-9. [PMID: 16721643 DOI: 10.1007/s11136-005-5149-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2005] [Indexed: 10/24/2022]
Abstract
This study is presenting the translation and cultural adaptation into Greek of the Quality of Life in Epilepsy Inventory (QOLIE-31). We adapted the QOLIE-31 to Greek through a procedure of translation-back-translation. Sixty-three patients were interviewed and completed the QOLIE-31 and the GHQ questionnaires. We re-examined a subset of them after a period of 2-5 weeks to evaluate the test-retest reliability of the questionnaire. We assessed the convergent validity by comparison of the QOLIE-31 and the GHQ and QOLIE-31 subscales and external measures. Discriminative validity was evaluated using the method of known-groups comparisons. The internal consistency was high for the QOLIE-31 and its' subscales (Cronbach's alpha 0.92 and 0.59-0.83 respectively). Test-retest reliability was acceptable (intra-class correlation coefficient 0.49-0.89 and Pearson's coefficient 0.53-0.92) for the group of patients who were re-examined. Comparison of the QOLIE-31 and GHQ scores showed agreement between the two questionnaires (Pearson's coefficient -0.61). We demonstrated the discriminative validity by the difference in the QOLIE-31 scores between patients with different seizure frequencies and different employment status. We concluded that the Greek version of the QOLIE-31 has psychometric properties equivalent to those of the original American-English version and is a valid and reliable instrument.
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Affiliation(s)
- Haritomeni Piperidou
- Department of Neurology, Democritus University of Thrace, Alexandroupoli, Greece
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Psychometric properties of the Bulgarian version of the Quality of Life in Epilepsy Inventory (QOLIE-31). Epilepsy Behav 2013; 28:203-10. [PMID: 23770634 DOI: 10.1016/j.yebeh.2013.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 11/20/2022]
Abstract
The purpose of the present study was to evaluate the psychometric properties of the Bulgarian version of the Quality of Life in Epilepsy Inventory (QOLIE-31). After a translation and cultural adaptation into Bulgarian of the US version of the QOLIE-31, the reliability and construct validity of the questionnaire were assessed in 106 adults with epilepsy. After a neurological assessment, all eligible patients were enrolled consecutively from an unselected patient population and completed the QOLIE-31. As part of the same study, they were screened for comorbid depressive disorder according to the ICD-10 diagnostic criteria and evaluated on the Hamilton Depression Rating Scale (HAMD-17). Reliability was tested both by assessing internal consistency and by the test-retest method. Construct validity was tested by factor analysis and multitrait/multi-item analysis (MAP-R) and the known-group comparison validation. Validity testing was completed by analysis of variance (ANOVA) for the QOLIE-31 scores against external measures (demographic and clinical variables). The domains showed high internal consistency (Cronbach's α: 0.78-0.97; 0.95 for the overall score). Test-retest reliability was good (an intraclass correlation coefficient ranging from 0.59 to 0.94 and a Pearson's coefficient ranging from 0.64 to 0.94). Item-scale correlations were high for all domains although exploratory factor analysis did not reach solutions that exactly matched those obtained from originally designed domains. All QOLIE-31 dimensions were sensitive to the tested demographic and clinical variables, except for Medication effects (sensitive to sex). Discriminative validity was demonstrated by the difference in QOLIE-31 scores between patients with different seizure frequencies, employment status, educational levels, and depression scores. The Bulgarian version of the QOLIE-31 questionnaire is reliable and valid for assessing the quality of life of patients with epilepsy.
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Health-related quality of life in Russian adults with epilepsy: the effect of socio-demographic and clinical factors. Epilepsy Behav 2012; 25:670-5. [PMID: 23158775 DOI: 10.1016/j.yebeh.2012.09.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 09/27/2012] [Accepted: 09/29/2012] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate socio-demographic and clinical factors influencing the health-related quality of life (HRQOL) of adult patients with epilepsy in a naturalistic treatment setting in Russia. METHODS The QOLIE-31 questionnaire and the Beck Depression Inventory (BDI) were completed by 208 patients with a broad clinical spectrum of epilepsy (the mean age was 31.49±13.20 years and ranged from 18 to 74 years). RESULTS In Russian adult patients with epilepsy, lower mean QOLIE-31 scores were obtained compared with previously published international data for overall HRQOL, emotional well-being, and cognitive functioning and social functioning subscales (p<0.001). Univariate analysis revealed that duration of epilepsy negatively correlated with all QOLIE-31 subscores (p<0.05), except for emotional well-being (p=0.1). In multivariate regression analysis, BDI depression score was the predictor of overall score and all QOLIE-31 domains, except for emotional well-being. Age could be considered as a predictor of cognitive and social functioning, medical effects, and the total QOLIE -31 score. Seizure frequency was a factor associated with all HRQOL domains, except for medication effects and emotional well-being, whereas gender, education, family status, seizure type, employment, lateralization of epileptic foci, number of antiepileptic drugs, and the reported adverse events did not significantly affect HRQOL. CONCLUSION The present study has revealed that longer duration of epilepsy, older age, higher seizure frequency, and depression are the potential predictors of worse HRQOL in adult Russian patients with epilepsy.
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Stavrinides P, Constantinidou F, Anastassiou I, Malikides A, Papacostas S. Psychosocial adjustment of epilepsy patients in Cyprus. Epilepsy Behav 2012; 25:98-104. [PMID: 22871254 DOI: 10.1016/j.yebeh.2012.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/29/2012] [Accepted: 05/30/2012] [Indexed: 11/29/2022]
Abstract
This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-three patients under 55 years of age with idiopathic or symptomatic epilepsy and 89 neurologically matched healthy volunteers participated. Subjects completed the State and Trait Anxiety Inventory and the Beck Depression Inventory; patients with epilepsy also completed the Epilepsy Foundation Concerns Index. Results showed that patients with symptomatic epilepsy had significantly higher scores on state and trait anxiety and depressive symptoms. Sociodemographic characteristics including gender, marital status, and education levels contributed to differences in trait and state anxiety, depressive symptom scales, autonomy concerns, and fear for seizure recurrence. Variables such as poor seizure control and use of polytherapy were associated with lower adjustment scores and reduced psychosocial outcome. Finally, patients with epilepsy scored significantly higher on depression and anxiety symptoms. The results provide further evidence on challenges patients with epilepsy face and on the need for implementing psychosocial prevention programs.
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Soria C, Escolano S, El Sabbagh S, Chmura S, Bulteau C, Chiron C, Dellatolas G. Behavioral problems, cognitive difficulties and quality of life in children with epilepsy: An analysis of parental concerns. Child Neuropsychol 2012; 18:209-27. [DOI: 10.1080/09297049.2011.602012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lua PL, Neni WS. Awareness, knowledge, and attitudes with respect to epilepsy: an investigation in relation to health-related quality of life within a Malaysian setting. Epilepsy Behav 2011; 21:248-54. [PMID: 21576038 DOI: 10.1016/j.yebeh.2011.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/27/2011] [Accepted: 03/30/2011] [Indexed: 11/28/2022]
Abstract
The influence of awareness, knowledge, and attitudes (AKA) on the health-related quality of life (HRQoL) of patients with epilepsy has not been widely established. The aims of this preliminary study were to (1) assess general AKA and HRQoL levels, (2) correlate AKA and HRQoL levels, and (3) compare the HRQoL of patients with epilepsy with different AKA levels. A cross-sectional sample of outpatients with epilepsy were recruited from the Neurology Clinic, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia. Data analysis was carried out using the Statistical Package for Social Sciences Version 15 employing descriptive and nonparametric statistics. On written consent, included patients completed the Malay AKA Epilepsy and the Malay Quality of Life in Epilepsy-30 (MQOLIE-30) instruments. Across all patients, both AKA levels (median: 80.0, range: 0-170) and overall HRQoL (median 51.5; range 15-97) were moderate. Awareness was significantly correlated only with Seizure Worry (r(s)=+0.29, p<0.05), whereas Knowledge was not significantly linked to any domain. However, Attitudes was significantly correlated with all domains (r(s)=+0.35 to +0.47, p<0.01) except Medication Effects and Seizure Worry. Patients with good AKA levels (Total Score ≥ median) experienced significantly better Overall Quality of Life and Cognitive Functioning (p<0.05). Findings showed that AKA may play an important role in influencing patients' HRQoL, suggesting that epilepsy treatment efforts should also focus on enhancing AKA through epilepsy awareness to improve health outcomes.
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Affiliation(s)
- Pei Lin Lua
- Centre for Clinical and Quality of Life Studies, Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia.
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Gordon-Perue G, Gayle F, Fraser R, Ali A. Quality of life of patients with epilepsy living in Kingston, Jamaica. Epilepsy Behav 2011; 21:23-6. [PMID: 21458384 DOI: 10.1016/j.yebeh.2011.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 02/01/2011] [Accepted: 02/12/2011] [Indexed: 11/19/2022]
Abstract
Quality of life in epilepsy has not been documented in the English-speaking Caribbean. The aim of this study was to explore the quality of life of persons with epilepsy (PWE) living in Jamaica and determine the impact of socioeconomic factors by examining two socially distinct groups in semiprivate (Epilepsy Centre of Jamaica) and public (Kingston Public Hospital) outpatient clinics. One hundred nine consecutive patients were interviewed. Quality of life was assessed using the Quality of Life in Epilepsy-31 inventory (QOLIE-31). Both groups were matched for gender, epilepsy syndrome, epilepsy duration, and number of antiepileptic drugs. Predictors of quality of life included number of antiepileptic drugs (P=0.039), epilepsy duration (P<0.05), and functional status (P<0.001). Neither seizure frequency nor socioeconomic status predicted QOLIE-31 scores. Mean QOLIE-31 total score (61.57 vs 49.2, P<0.001) and QOLIE-31 subscale scores (with the exception of the Seizure Worry score [53.8 vs 48.2, P=0.08]) were significantly higher than the corresponding t scores. The QOLIE-31 can reliably be used in Jamaica. Our findings suggest Jamaicans living with epilepsy perceive themselves as having a better than expected quality of life.
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Affiliation(s)
- G Gordon-Perue
- Department of Medicine, University Hospital of the West Indies, Mona, Jamaica.
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Kwon OY, Park SP. What is the role of depressive symptoms among other predictors of quality of life in people with well-controlled epilepsy on monotherapy? Epilepsy Behav 2011; 20:528-32. [PMID: 21354863 DOI: 10.1016/j.yebeh.2011.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 01/05/2011] [Accepted: 01/06/2011] [Indexed: 11/29/2022]
Abstract
The quality of life (QOL) of individuals with well-controlled epilepsy (WCE) is often not considered. We therefore investigated predictors determining QOL in patients who had been seizure free at least 1 year on stable antiepileptic drug (AED) monotherapy. They were asked to complete self-report health questionnaires, including the Beck Depression Inventory (BDI), Adverse Event Profile (AEP), and Quality of Life in Epilepsy Inventory-31 (QOLIE-31). We looked for predictors of QOLIE-31 scores among the various demographic, socioeconomic, and clinical factors and BDI, and AEP scores. Depression symptoms were manifested by 18.7% of patients. People with depression symptoms were more likely to report adverse events than those without depression symptoms. The strongest predictor of QOL was BDI score, followed by AEP total score, years of education, and income. BDI score had 3.37 times the effect of AEP total score. In conclusion, QOL of patients with WCE is determined mainly by depressive symptoms.
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Affiliation(s)
- Oh-Young Kwon
- Department of Neurology and Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Clinical and demographic characteristics predicting QOL in patients with epilepsy in the Czech Republic: How this can influence practice. Seizure 2009; 18:85-9. [DOI: 10.1016/j.seizure.2008.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 05/30/2008] [Accepted: 06/20/2008] [Indexed: 11/18/2022] Open
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Ekinci O, Titus JB, Rodopman AA, Berkem M, Trevathan E. Depression and anxiety in children and adolescents with epilepsy: prevalence, risk factors, and treatment. Epilepsy Behav 2009; 14:8-18. [PMID: 18804186 DOI: 10.1016/j.yebeh.2008.08.015] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 08/21/2008] [Accepted: 08/26/2008] [Indexed: 11/19/2022]
Abstract
Among the psychiatric comorbid conditions in children and adolescents with epilepsy, depression and anxiety disorders require further attention because they carry the risk of reduced quality of life and life-threatening complications (e.g., suicide). Research in recent years has shed light on both the prevalence of emotional problems in youth with epilepsy and the safety and efficacy of treatment options. A number of challenges exist in treating patients with epilepsy. This is particularly true when seizures are difficult to control and medication regimens are more complex. Some pharmaceutical options may provide assistance with both seizures and emotional distress, but care is needed when considering such treatment approaches. In addition, integration of mental health professionals into the care of patients is necessary when cases are complicated and risk factors are high. Thorough methods to accurately diagnose emotional conditions and regular monitoring of symptoms can help prevent serious problems that can negatively affect the success of children and adolescents in everyday life. Collaboration between disciplines offers the best hope for early identification and treatment of these conditions.
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Affiliation(s)
- Ozalp Ekinci
- Department of Child Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey.
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Auriel E, Landov H, Blatt I, Theitler J, Gandelman-Marton R, Chistik V, Margolin N, Gross B, Parmet Y, Andelman F, Neufeld MY. Quality of life in seizure-free patients with epilepsy on monotherapy. Epilepsy Behav 2009; 14:130-3. [PMID: 18926930 DOI: 10.1016/j.yebeh.2008.09.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 09/23/2008] [Accepted: 09/23/2008] [Indexed: 11/29/2022]
Abstract
Epilepsy is a multifaceted chronic disorder which has diverse and complex effects on the well-being of the patient. Although it is evident that seizure type and frequency play a critical role in the quality of life (QOL) of patients with epilepsy, it is less clear what the major determinants are that influence QOL in seizure-free patients receiving monotherapy. The aim of this study was to evaluate demographic, clinical, and socioeconomic factors influencing the QOL of seizure-free patients receiving monotherapy. All participants were patients from four medical centers who had epilepsy, were on monotherapy, and had been seizure-free for at least 1 year. Responders completed three questionnaires on demographic and clinical information, QOL, and antiepileptic drug (AED) side effects during routine follow-up visits in the epilepsy clinics. We present the data of 103 patients: 59 females (57.3%), mean age 37.75+/-13.66 years. Treatment side effects and unemployment (p<0.0001, p=0.037, respectively) were significant predictors for poor overall QOL, whereas age, gender, education, family status, comorbidity, seizure type, age of seizure onset, and epilepsy duration did not significantly affect overall QOL. There was no significant difference in side effects and QOL between patients receiving older versus newer AEDs. Ninety-four (92.2%) patients reported experiencing at least one side effect of AEDs when queried about specific symptoms, while only 11 (10.7%) patients replied affirmatively when asked whether they experienced "any" side effects. The most common side effects involved the central nervous system. In conclusion, this study reveals that the most significant factor influencing the QOL in seizure-free patients on monotherapy is AED side effects. QOL is a crucial component in the clinical care of patients with epilepsy, and physicians should take the time to ask specific questions on side effects of AEDs.
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Affiliation(s)
- Eitan Auriel
- Department of Neurology, Tel Aviv Medical Center, Tel Aviv 64239, Israel.
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Piazzini A, Beghi E, Turner K, Ferraroni M. Health-related quality of life in epilepsy: findings obtained with a new Italian instrument. Epilepsy Behav 2008; 13:119-26. [PMID: 18396465 DOI: 10.1016/j.yebeh.2008.02.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 02/25/2008] [Accepted: 02/29/2008] [Indexed: 10/22/2022]
Abstract
The aim of the present study was to evaluate the Epi-QoL, a new Italian-specific measure of health-related quality of life (HRQOL) for adults with epilepsy; the clinical variables that affected the HRQOL score were also assessed. The Epi-QoL is a 46-item self-administered questionnaire focusing on six domains: Physical Functioning, Cognitive Functioning, Emotional Well-Being, Social Functioning, Seizure Worry, and Medication Effects. Eight hundred fifteen patients recruited from 24 secondary and tertiary Italian centers for the care of epilepsy were assessed. The results supported the reliability and validity of the Epi-QoL as a measure of HRQOL. The variables that significantly affected HRQOL scores were: geographic area, gender, seizure frequency, prognostic categories, number of medications, comorbidity, presence of cognitive impairment, psychiatric disturbances, and disability. We believe that a new specific questionnaire for the evaluation of HRQOL in Italy can contribute much to the understanding of the influence of epilepsy on patients' lives.
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Affiliation(s)
- Ada Piazzini
- Epilepsy Center, St Paolo Hospital, Milan, Italy.
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Baxendale S. The impact of epilepsy surgery on cognition and behavior. Epilepsy Behav 2008; 12:592-9. [PMID: 18299253 DOI: 10.1016/j.yebeh.2007.12.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 12/25/2007] [Indexed: 10/22/2022]
Abstract
Famous historical cases and current clinical experience clearly indicate that the success of epilepsy surgery cannot be judged with the basic algorithm "fewer seizures = better outcome." Many factors combine and entwine with the experience of medically intractable seizures to create associated patterns of behavior and cognition. Obtaining freedom from seizures does not automatically undo the historical tangle of these salient factors, many of which remain or are exacerbated after surgery. This review examines the preoperative, perioperative, and postoperative factors that influence postoperative cognition and behavior in adult patients with temporal lobe epilepsy. Consistent findings from group studies have long masked the considerable individual variations in cognitive and behavioral outcomes following surgery. Although more recent multivariate studies provide useful clinical data for prospective surgical candidates, comprehensive long-term follow-up studies are rare. We have certainly become more proficient at measuring both cognitive and behavioral outcomes following surgery, although the ecological validity of many follow-up measures, particularly in the cognitive domain, remains low. A reliance on test scores can mask significant differences in strategy, which can also be used as a sign of lateralized dysfunction. A shift away from the "can do versus can't do" approach to the assessment of cognitive strategies may hold the key to more meaningful pre- and postoperative cognitive assessments from the patient's perspective. Emergent functional imaging paradigms show much promise in this regard. A renewed focus on cognitive strategies may also be useful in planning postoperative rehabilitation programs. New directions for outcome research in epilepsy surgery are suggested with an emphasis on a patient-centered approach.
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Affiliation(s)
- Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, Institute of Neurology UCL, Queen Square, London, UK.
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McLaughlin DP, Pachana NA, Mcfarland K. Stigma, seizure frequency and quality of life: The impact of epilepsy in late adulthood. Seizure 2008; 17:281-7. [DOI: 10.1016/j.seizure.2007.09.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 08/16/2007] [Accepted: 09/06/2007] [Indexed: 10/22/2022] Open
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Townshend KH, Dorris L, McEwan MJ, Aylett SE, Brodie MJ, O'Regan M, Espie CA. Development and validation of a measure of the impact of epilepsy on a young person's quality of life: Glasgow epilepsy outcome scale for young persons (GEOS-YP). Epilepsy Behav 2008; 12:115-23. [PMID: 17983839 DOI: 10.1016/j.yebeh.2007.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 09/05/2007] [Accepted: 09/05/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The goal of the work described here was to develop and validate a measure of the impact of epilepsy on an adolescent's quality of life that is based on direct exploration of the adolescent's views. METHODS Initial scale development was based on data generated through qualitative methods (focus groups) in a previous study [McEwan MJ, Espie CA, Metcalfe J, Brodie MJ, Wilson MT. Seizure 2004;13:15-31]. A draft measure was piloted (n=30) and refined using correlational methods. Psychometric properties were established by means of a preliminary field trial (n=78). RESULTS An initial item pool of 76 was refined to 50. The structure of the measure mirrored the conceptual model derived from focus group study; Part 1 covered issues relating to adolescent development (identity formation) with five subscales, and Part 2 covered epilepsy-related issues with four subscales. The final GEOS-YP had good internal consistency (alpha=0.91) and test-retest reliability (rho=0.75). Concurrent and construct validity was acceptable, and the GEOS-YP discriminated on dimensions of clinical importance. Participant feedback suggested the measure has excellent face validity and potential clinical utility. CONCLUSIONS The GEOS-YP is a direct measure of how adolescents perceive epilepsy impacts their quality of life. The GEOS-YP has sound psychometric properties and provides a relatively brief and potentially useful clinical outcome tool.
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Affiliation(s)
- Kathryn H Townshend
- Department of Clinical Psychology, Royal Hospital for Sick Children, Yorkhill, Dalnair St, Glasgow, G3 8SJ Scotland, UK
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Senol V, Soyuer F, Arman F, Oztürk A. Influence of fatigue, depression, and demographic, socioeconomic, and clinical variables on quality of life of patients with epilepsy. Epilepsy Behav 2007; 10:96-104. [PMID: 17097354 DOI: 10.1016/j.yebeh.2006.08.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 08/04/2006] [Accepted: 08/08/2006] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to define the influence of fatigue, depression, and clinical, demographic, and socioeconomic factors on the quality of life of patients with epilepsy. The study was performed on 103 adult patients who visited Erciyes University Epilepsy Outpatient Clinic between 2004 and 2005. Patients were evaluated with the Form of Negotiation, Quality of Life in Epilepsy Inventory (QOLIE-89), Beck Depression Inventory, and Fatigue Severity Scale. Mean age of the patients was 34.3+/-12.6, and mean duration of disease was 12.6+/-9.3 years. Among these patients, 52.4% were men, 49.5% were married, 15.5% had a university education, 53.4% had low incomes, 45.6% had generalized seizures, and 35.0% had experienced one or more seizures per month during the preceding year. The most significant variables in the domain of Overall quality of life were seizure frequency (P<0.001), depression (P<0.001), and fatigue (P<0.001); the variables in the domain of Mental Health were seizure frequency (P<0.001) and fatigue (P<0.001); the variable in the Cognitive domain was fatigue (P<0.001); the variables in the domain of Physical Health were social insurance coverage (P<0.01), fatigue (P<0.01), and age (P<0.01); the variables in the Epilepsy Targeted domain were depression (P<0.001), seizure frequency (P<0.001), and fatigue (P<0.01). Although quality of life has multiple determinants, seizure frequency, fatigue, and depression are the most important factors affecting quality of life in patients with epilepsy. One or more seizures per month, severe fatigue, and depression are associated with lower quality of life in some but not all domains. Partial correlations demonstrated that fatigue was a significant independent predictor of quality of life. The present study confirms that fatigue can be a powerful predictor of quality of life.
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Affiliation(s)
- Vesile Senol
- Halil Bayraktar Health Services, Vocational College, Erciyes University, Kayseri, Turkey.
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Räty LKA, Wilde Larsson BM. Quality of life in young adults with uncomplicated epilepsy. Epilepsy Behav 2007; 10:142-7. [PMID: 17126608 DOI: 10.1016/j.yebeh.2006.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 09/20/2006] [Accepted: 09/25/2006] [Indexed: 11/29/2022]
Abstract
This aim of this study was to illuminate quality of life (QOL) of young adults with epilepsy. Subjects (n=102) answered the Quality of Life Index (QLI) questionnaire together with an overall open question (n=95/102) regarding the impact of epilepsy on daily life. The highest QOL was reported in relation to the family domain, and the lowest, in relation to the psychological/spiritual domain. Overall the participants were satisfied with their lives. Most important were the well-being of their families, their relationships with their spouses, and their ability to control their lives. Half of the participants experienced a negative effect of epilepsy on their daily lives. Of those, 70% considered the effect insignificant or small. This study supports the conclusions that uncomplicated epilepsy does not significantly affect QOL in young adulthood and that the risk of social isolation due to uncomplicated epilepsy is not significantly increased.
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Affiliation(s)
- Lena K A Räty
- Faculty of Social and Life Sciences, Department of Nursing, Karlstad University, SE-651 88 Karlstad, Sweden.
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Connolly AM, Northcott E, Cairns DR, McIntyre J, Christie J, Berroya A, Lawson JA, Bleasel AF, Bye AME. Quality of life of children with benign rolandic epilepsy. Pediatr Neurol 2006; 35:240-5. [PMID: 16996395 DOI: 10.1016/j.pediatrneurol.2006.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 02/10/2006] [Accepted: 03/27/2006] [Indexed: 10/24/2022]
Abstract
The first objective of this study was to determine the quality of life of children with benign rolandic epilepsy. Secondly, this investigation aimed to predict the influence of cognition on quality of life, controlling for the emotional impact of the epilepsy on the parent. Initial recruitment was through the major electroencephalography laboratories of metropolitan Sydney. The syndrome was defined using the International League Against Epilepsy classification. Patients underwent a comprehensive cognitive assessment, and parents completed the Child Health Questionnaire, Child Behavior Checklist, and Quality of Life in Childhood Epilepsy Questionnaire. Parental emotional impact was assessed using a subscale from the Child Health Questionnaire. The cohort included 30 patients (22 males, 8 females), mean age 9.67 years. There was a higher incidence of competence problems compared with normative data. The average psychosocial score was significantly lower than normative data. Controlling for parental emotional impact, general intellectual ability predicted quality of life in the areas of self-esteem and language. Clinical variables had minimal impact and were not included in the regression models. Parental emotional impact, however, was a major independent predictor of quality of life. Quality of life may be compromised in children with benign rolandic epilepsy and is related to cognitive variables and emotional impact of the epilepsy on the parent.
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Affiliation(s)
- Anne M Connolly
- School of Women's and Children's Health, University of New South Wales, Department of Speech Pathology, Sydney Children's Hospital, New South Wales, Australia
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Meldolesi GN, Picardi A, Quarato PP, Grammaldo LG, Esposito V, Mascia A, Sparano A, Morosini P, Di Gennaro G. Factors associated with generic and disease-specific quality of life in temporal lobe epilepsy. Epilepsy Res 2006; 69:135-46. [PMID: 16515856 DOI: 10.1016/j.eplepsyres.2006.01.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 01/12/2006] [Accepted: 01/25/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed at further elucidating the association between quality of life (QOL) and sociodemographic factors, clinical seizure factors, depression and anxiety in drug-resistant temporal lobe epilepsy (TLE). METHODS We studied 106 consecutive adult right-handed patients (mean age 35.4 +/- 9.7; 50% males; IQ> or = 70) with drug-resistant unilateral (59% right) TLE (70% hippocampal sclerosis, 30% tumors or other lesions), who underwent a comprehensive non-invasive pre-surgical protocol. They completed the Beck Depression Inventory (BDI) and the State Form of the Spielberger State-Trait Anxiety Inventory (STAI). To measure QOL, we used both a generic instrument, the WHOQOL-100, and a disease-specific instrument, the 31-item quality of life in epilepsy (QOLIE-31). Multiple linear regression analysis was used to examine the relationship between each QOL domain and age, gender, education, side of TLE, duration of epilepsy, seizure frequency, and level of depression and anxiety. RESULTS Severity of depressive symptoms was significantly associated with lower scores across most QOL domains. Depression was consistently the strongest predictor of lower scores on almost all QOL domains. Also, severity of anxiety symptoms was significantly associated with lower scores across many QOL domains. Independent significant relationships between QOL and sociodemographic or clinical epilepsy variables were limited in number and strength. CONCLUSIONS Our findings suggest that QOL in TLE might be substantially affected by the presence and severity of depressive symptoms and, to a lesser degree, of anxiety symptoms. While clinical seizure variables had a weaker association with QOL, the absence of seizure-free patients might have obscured a relation between seizure frequency and QOL. Healthcare professionals should be aware of the significance of patients' emotional state and of the role it plays for their QOL. Adopting a biopsychosocial approach might be useful to address patients' needs.
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Affiliation(s)
- Giulio N Meldolesi
- Epilepsy Surgery Unit, Department of Neurological Sciences, IRCCS Neuromed, Pozzilli (IS), Italy
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Wilson SJ, Bladin PF, Saling MM, Pattison PE. Characterizing psychosocial outcome trajectories following seizure surgery. Epilepsy Behav 2005; 6:570-80. [PMID: 15907751 DOI: 10.1016/j.yebeh.2005.02.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Revised: 02/22/2005] [Accepted: 02/23/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE We have developed a new approach to characterizing psychosocial outcome after seizure surgery that allows us to identify diverse individual trajectories as well as subgroups of patients with similar outcomes. METHODS Eighty-nine anterior temporal lobectomy (ATL) patients were recruited through our Seizure Surgery Follow-up and Rehabilitation Program. The Austin CEP Interview was used to measure psychosocial adjustment presurgery, at discharge, and 1, 3, 6, 12, and 24 months postsurgery. Patient outcome trajectories were characterized across this time frame using a profile-focused form of dual clustering that leads to a lattice representation. RESULTS Two major, distinct outcome subgroups were identified. Fifty-eight percent (58%) of patients reported good outcomes, characterized by improved family dynamics, enhanced vocational and social functioning, and driving by 24 months postsurgery. A range of trajectories led to these outcomes, including the experience of early postoperative adjustment difficulties. In contrast, 31% of patients perceived their outcomes as poor, reporting affective disturbance at 12 months and difficulties discarding sick role behaviors. Early anxiety served as a marker of poor outcomes, while resolution of early anxiety and vocational change at 12 months were indicators of good outcomes at 24 months. The remaining 11% of patients reported minimal adjustment features. CONCLUSIONS For the majority of patients, seizure surgery gives rise to an evolving process of postoperative adjustment that leads to distinct outcome trajectories. Our approach questions the clinical sensitivity of health-related quality of life measures that average across patients to provide a unitary measure of outcome. Although preliminary, the findings have implications for postoperative treatment, including the identification of markers of longer-term outcomes.
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Affiliation(s)
- Sarah J Wilson
- Comprehensive Epilepsy Program, Epilepsy Research Institute, Austin Hospital, Melbourne, Australia.
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de Weerd A, de Haas S, Otte A, Trenité DKN, van Erp G, Cohen A, de Kam M, van Gerven J. Subjective sleep disturbance in patients with partial epilepsy: a questionnaire-based study on prevalence and impact on quality of life. Epilepsia 2004; 45:1397-404. [PMID: 15509241 DOI: 10.1111/j.0013-9580.2004.46703.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE This study was designed to assess whether sleep disturbance is more frequent among patients with partial seizures and what impact on quality of life (QoL) sleep disturbance may have on patients with partial seizures. METHODS Questionnaire booklets were mailed to 1,183 patients from four Dutch clinics. Each patient was asked to find two age- and gender-matched controls to complete the same set of questionnaires [Sleep Diagnosis List (SDL), Medical Outcomes Study (MOS)-Sleep Scale, Groningen Sleep Questionnaire, Epworth Sleepiness Scale, and the SF-36 Health Survey]. The prevalence of sleep disturbance, based on the SDL, was compared between those with partial epilepsy and controls. Mean scores on sleep and the SF-36 Physical (PCS) and Mental (MCS) Component Summary scales were compared. RESULTS Responses from 486 patients and 492 controls were analyzed. Respondents with partial epilepsy had a highly significant, twofold higher prevalence of sleep disturbance compared with controls (38.6 vs. 18.0%; p < 0.0001). Most sleep-disorder subscales showed significant abnormalities in respondents with epilepsy, compared with controls. Mean SF-36 MCS and PCS scores were significantly lower in respondents with epilepsy compared with controls in both the strata with sleep disturbance and without (all p values <0.05). The presence of a sleep disturbance in respondents with epilepsy was associated with the greatest impairment in QoL. CONCLUSIONS Sleep disturbance is more than twice as prevalent in persons with partial epilepsy compared with controls, and most domains of sleep are significantly disturbed. Persons with partial epilepsy have significant QoL impairment, and sleep disturbance further compounds this.
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Affiliation(s)
- Al de Weerd
- Centre for Sleep & Wake Disorders, Medical Centre Haaglanden, Westeinde Hospital, The Hague, The Netherlands.
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Mrabet H, Mrabet A, Zouari B, Ghachem R. Health-related Quality of Life of People with Epilepsy Compared with a General Reference Population: A Tunisian Study. Epilepsia 2004; 45:838-43. [PMID: 15230710 DOI: 10.1111/j.0013-9580.2004.56903.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The goal of the study was to assess the health-related quality of life (HRQOL) of persons with epilepsy (PWE) by using the short form survey 36 (SF-36), to compare it with that of a control group and to detect factors influencing it. METHODS We collected clinical and demographic data and information on health status by using the Arabic translation of the SF-36 questionnaire from two groups: (a) 120 PWE consulting our outpatient clinic during a period of 4 months, and (b) 110 Tunisian citizens, representative of the Tunisian general population, as a control group. RESULTS The mean age of PWE group was 32.74 years, and 45.5% were men. Idiopathic generalized epilepsies were observed in 44.5% of cases, and symptomatic partial epilepsies, in 30%. The most commonly prescribed drug was sodium valproate (VPA). For the SF-36, PWE had lower scores than the control group for only three subscales: general health perception, mental health, and social functioning. Seizure frequency, time since last seizure, and the antiepileptic drug (AED) side effects were the most important variables influencing the HRQOL among PWE. Seizure-free adults have HRQOL levels comparable to those of the control group. Sociodemographic variables had no influence on the SF-36 subscales. CONCLUSIONS HRQOL is impaired in Tunisian PWE. The influencing factors identified in this study differ from the previously published data. Several possible reasons such as family support and cultural and religious beliefs are proposed to explain these cross-cultural differences. A larger study should be conducted to verify such findings.
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Affiliation(s)
- Hela Mrabet
- Department of Neurology, Charles Nicolle Hospital, Tunis, Tunisia
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Quelles échelles de qualité de vie pour les patients atteints d’EPPR. Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The consequences of epilepsy can be quite severe and include shortened lifespan, excessive bodily injury, neuropsychological and psychiatric impairment, and social disability. There is evidence that seizures cause brain injury, including neuronal death and physiological dysfunction. Mortality rates are 4-7 times higher in people with medically refractory seizures, and injury rates are substantial, ranging from one per 20 person-years to as much as one per 3 person-years. Quality of life is impaired in epilepsy, and relates to seizure control. Psychosocial disabilities, including lower social interaction with reduced marriage rates and reduced employment levels, are more common in people with refractory seizures. Complete seizure control is desirable, since seizures potentially constitute a serious threat to health and well-being. Therefore, satisfactory seizure control should be defined as having no seizures. Treatment should be directed to preventing seizures whenever possible and achieving control early in the course of illness. The risks of uncontrolled seizures outweigh the risks of aggressive medical or surgical therapy.
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Affiliation(s)
- Michael R Sperling
- Department of Neurology, Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Abstract
PURPOSE The goal of this study was to assess the patient-perceived costs and benefits associated with the longer-term outcomes of epilepsy surgery in patients who underwent anterior temporal lobectomy or selective amygdalohippocampectomy. METHODS Surgery patients who were assessed in 1997 were reassessed in 2003. Demographic, clinical, and psychosocial details were collected using a validated self-completion questionnaire. Data were collected from 67 patients who had undergone surgery. RESULTS Forty-five percent were seizure-free. There were significant differences (P<0.001) between the seizure-free (SF) and continuous seizure (CS) groups with respect to anxiety, depression, impact of epilepsy, self-esteem, mastery, stigma, affect balance, self-reported health, and quality of life. More SF patients were also employed and driving (P<0.001). Despite these differences there were no differences for regret over surgery but there were differences for satisfaction and success ratings. CONCLUSIONS Patients who were not SF, in the longer term, had little regret undergoing surgery but were less likely to be satisfied and had a poorer psychosocial profile.
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Affiliation(s)
- Katie Reid
- University Department of Neurosciences, The Centre for Research and Education, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK
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Sabaz M, Lawson JA, Cairns DR, Duchowny MS, Resnick TJ, Dean PM, Bye AME. Validation of the quality of life in childhood epilepsy questionnaire in American epilepsy patients. Epilepsy Behav 2003; 4:680-91. [PMID: 14698702 DOI: 10.1016/j.yebeh.2003.08.012] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aim of this study was to adapt the Australian Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) and determine its psychometric properties in a North American population. Participants were North American families with children diagnosed with epilepsy. Parents were asked to complete the American QOLCE (USQOLCE) and the Child Health Questionnaire (CHQ). Seventy-one families completed the USQOLCE. The internal consistency reliability of the subscales was good. USQOLCE subscales correlated highly with theoretically similar subscales contained in the CHQ. Theoretically dissimilar subscales on the two instruments did not correlate as well. USQOLCE correlated significantly with a parental rating of seizure severity and an independent measure of degree of postoperative seizure control. This study demonstrated that the USQOLCE is suitable for a North American population with evidence of its reliability and validity including its sensitivity to seizure burden.
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Affiliation(s)
- Mark Sabaz
- Department of Psychology, Macquarie University, NSW 2109, Sydney, Australia
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Williams J, Steel C, Sharp GB, DelosReyes E, Phillips T, Bates S, Lange B, Griebel ML. Parental anxiety and quality of life in children with epilepsy. Epilepsy Behav 2003; 4:483-6. [PMID: 14527488 DOI: 10.1016/s1525-5050(03)00159-8] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parental beliefs and attitudes concerning epilepsy may significantly impact adjustment and quality of life for both the child and family. The purpose of the present study was to examine the relationship between parental anxiety and quality of life in pediatric patients with ongoing epilepsy. Subjects were parents (n=200) of children between the ages of 6 and 16 years who had been diagnosed and treated for epilepsy for at least 1 year. Parents were given quality of life and anxiety questionnaires during the child's clinic visit. A stepwise regression analysis suggested that severity of comorbid conditions, parental anxiety, seizure control, and number of medications were significantly associated with quality of life for these children. Parents with increased anxiety whose children had poorly controlled seizures and a comorbid disability were found to have diminished quality of life.
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Affiliation(s)
- Jane Williams
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AK, USA.
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Ronen GM, Streiner DL, Rosenbaum P. Health-related quality of life in children with epilepsy: development and validation of self-report and parent proxy measures. Epilepsia 2003; 44:598-612. [PMID: 12681011 DOI: 10.1046/j.1528-1157.2003.46302.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To answer a need to include and measure accurately the impact and burden of epilepsy as outcomes of interventions with affected children, we developed and validated self-report and parent-proxy respondent health-related quality of life (HRQL) instruments for preadolescent children with epilepsy. METHODS We combined qualitative and quantitative research methods. Items were extracted from focus group discussions involving children with epilepsy and their parents. We created scales formatted with alternative paired options of forced responses and used factor analysis to generate relevant subscales and reduce the number of items. We checked internal consistency, assessed test-retest reliability 10-14 days apart, and documented construct validity. RESULTS A sample of 381 children with epilepsy, age 6-15 years, and their parents independently completed a 67-item questionnaire, from which we chose five items for each subscale. The measures share four subscales, but each measure has an additional distinct subscale. The children and parents could discern differences and report differentially between the various aspects of the HRQL. Internal consistency measured with Cronbach's alpha was acceptable for all subscales; construct validity has been demonstrated from the testing of several hypotheses. Test-retest reliability examined with the intraclass correlation coefficient was satisfactory for the parents and for children age 8 years and older. The correlations between the mothers' and children's responses was poor to moderate. CONCLUSIONS The data demonstrate sound psychometric properties for both related measures, which are easy to administer for children with epilepsy who are 8 years and older and their parents. The subscales encompass HRQL dimensions judged most important by children with epilepsy for the self-report measure and by parents for the proxy response measure. The parent-proxy measure should be useful as a complement to the child self-report measure in evaluating the validity of parental assessment of the child's health status; in longitudinal outcome research; and in HRQL assessment of children who are unable to respond independently.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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