[Quality of life of adult patients with cryptogenic epilepsy]

AIM

To determine a position of cryptogenic epilepsy (CE) in relation to idiopathic epilepsy (IE) and symptomatic epilepsy (SE) in the aspect of patients' quality-of-life.

MATERIAL AND METHODS

One hundred and fifty patients, including 90 with CE, 30 with SE and 30 with IE, were examined. The severity of epileptic seizures assessed with the NHS3, anxiety and depression assessed with the HADS, sleep disorders, quality-of-life measured with the Qolie-89 were studied.

RESULTS AND CONCLUSION

CE was similar to SE in many parameters but had a favorable course. The following factors were similar for CE and IE: family history of disease, differences between the severity of seizures and Qolie-89 scores. Quality-of-life was higher in CE compared to SE, despite the marked anxiety of patients. It has been concluded that CE, which is caused by both genetic and environmental factors, has an interim position between IE and SE.

Structural Equation Modeling in Rehabilitation Counseling Research

Structural equation modeling (SEM) has become increasingly popular in counseling, psychology, and rehabilitation research. The purpose of this article is to provide an overview of the basic concepts and applications of SEM in rehabilitation counseling research using the AMOS statistical software program.

The biopsychosocial model and quality of life in persons with active epilepsy

BACKGROUND

Despite a long recognized need in the field of the importance of the psychological and social factors in persons with epilepsy (PWE), the medical community has continued to focus primarily on seizures and their treatment (the biological-biomedical model). From the biopsychosocial perspective, a person's lived experience needs to be incorporated into the understanding of quality of life. While the biopsychosocial model has gained prominence over the years, it has not been studied much in epilepsy.

METHODS

The study sample included 1720 PWE from the 2003 and the 2005 Canadian Community Health Survey (CCHS). Data were analyzed using set correlation, as it allows for the examination of the relative contribution of sets of independent variables (biological, psychological, and social domains) and a set of dependent variables (quality of life) of interest, defined as self-rated health status, self-rated mental health status, and life satisfaction.

RESULTS

Results provide strong evidence that the full biopsychosocial model explained a significantly larger amount of variance in quality of life (R(2) = 55.0%) compared with the biological-biomedical model alone (R(2) = 24.8%). When the individual domains of the biopsychosocial model were controlled for, the psychological (R(2) = 24.6%) and social (R(2) = 18.5%) domains still explained a greater amount of the variance in quality of life compared with the biological-biomedical model (R(2) = 14.3%).

CONCLUSIONS

While seizure freedom will continue to be an important treatment goal in epilepsy, the psychological and social domains are an important consideration for both interventional programs and clinical research designed to improve quality of life in PWE. Better integration of social workers and psychologists into routine care may help address these disparities.

Positive Coping, Self-Efficacy, and Self-Esteem as Mediators Between Seizure Severity and Life Satisfaction in Epilepsy

This study examined the impact of positive psychological traits (positive coping, self-efficacy, and self-esteem) on the relationship between seizure severity and life satisfaction among individuals with epilepsy. Hierarchical regression analysis and correlation techniques were used to test a hypothesized tri-mediation model of life satisfaction for individuals with epilepsy. Results indicated that seizure severity and positive human traits, including positive coping, self-efficacy, and self-esteem, were indeed associated with overall life satisfaction. Self-efficacy and self-esteem (but not positive coping) fully mediated the relationship between seizure severity and life satisfaction, lending support for a dual-mediation model. These findings suggest there may be considerable value for rehabilitation psychologists and counselors to develop specialized intervention programs that focus on capitalizing these positive human traits to promote life satisfaction and well-being for clients with epilepsy.

Examining the relationships of depressive symptoms, stigma, social support and regimen-specific support on quality of life in adult patients with epilepsy

Epilepsy research efforts have primarily focused on medical treatment and physical management of epilepsy; however, to provide comprehensive care, efforts cannot focus solely on physical manifestations of epilepsy. Research findings show that people with epilepsy face many challenges that can negatively affect quality of life (QOL). In this descriptive study, we examined the individual relationships between depressive symptoms, stigma, social support and regimen-specific support and QOL in adults with epilepsy. Study data were obtained from a subset of patients (N = 147) who participated in a longitudinal study of adult patients with epilepsy. Measures of QOL, depressive symptoms, stigma, social support and regimen-specific support were analyzed to answer the research questions. The results of correlational analyses revealed statistically significant negative correlations between depressive symptoms, stigma and sometimes regimen-specific support and QOL and statistically significant positive correlations between social support and QOL. A hierarchical multiple linear regression model revealed that depressive symptoms accounted for the most variance in QOL. Psychosocial variables measured 3 months prior to QOL were entered into a hierarchical multiple linear regression model, revealing that depressive symptoms, stigma and social support can be used to predict QOL at a later time.

Family Resiliency, Uncertainty, Optimism, and the Quality of Life of Individuals With HIV/AIDS

The purpose of the study is to contribute to the understanding of quality of life as it is experienced by a community-based, nonclinical sample of individuals with HIV/AIDS by applying family resiliency theory and cognitive appraisal concepts of uncertainty and optimism. Through the use of a Web-based survey, 125 individuals with HIV/AIDS completed an online questionnaire. Disease progression, as measured by CD4 count, is not found to be related to quality of life. When considered separately, both the family resiliency variables and the cognitive appraisal variables are found to predict quality of life. The overall prediction model, composed of the three sets of predictor variables—cognitive appraisal, family resiliency, and disease progression—is found to explain over 60% of the variance in quality of life of people with HIV/AIDS.

Quality of life and associated factors among adults with epilepsy in Nigeria

OBJECTIVE

Epilepsy is a common condition worldwide and has been observed to affect quality of life (QOL). Though, much has been written on this subject among western populations, little research has been done in developing countries of Africa including Nigeria. The study aims to identify factors associated with quality of life among adult epilepsy patients in this environment.

METHOD

Respondents were evaluated using the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), the 30-item General Health Questionnaire (GHQ-30), the modified Mini Mental State Examination (mMMSE),and the Hospital Anxiety and Depression Scale (HADS). Diagnosis of epilepsy was based on clinical and electroencephalographic findings.

RESULTS

The mean age of the 51 respondents was 27.7 years (SD = 9.7). Thirteen (25.5%) had an average of 2 seizure episodes in the month preceding the interview, while 37 (72.5%) have had the condition for more than 5 years. Factors that were significantly associated with overall quality of life included being female (p < 0.05), seizure frequency (p < 0.01), using more than 1 anti-epileptic drugs (AEDs) (p < 0.01), GHQ-30 score (p < 0.01), high anxiety score (p < 0.001), and high depression score (p < 0.01). Multiple regression analysis showed that depressive symptoms were the single most important factor explaining low QOL. Other factors were GHQ-30 score, seizure frequency, and being a woman.

CONCLUSION

Controlling seizures and paying attention to the psychological needs of adult epileptics will have a positive effect on the QOL among Nigerian epileptics.

Epilepsy and employment: literature review

OBJECTIVE

The aim of this review is to increase understanding of the factors that affect the regular employment positions of people with epilepsy by means of the World Health Organization International Classification of Functioning, Disability, and Health (ICF) model.

METHOD

Thirty-four primary research articles describing factors associated with employment for people with epilepsy are reviewed.

RESULTS

People with epilepsy may face a number of complex and interacting problems in finding and maintaining employment. Stigma, seizure severity, and psychosocial variables such as low self-esteem, passive coping style, and low self-efficacy have been implicated as factors that play an important role in predicting employment. Findings demonstrate the need for specific employment training programs.

CONCLUSION

We recommend specific training interventions that focus on increasing the self-efficacy and coping skills of people with epilepsy so that these individuals will be able to accept their disorder and make personal and health-related choices that help them to achieve better employment positions in society.

Postsurgical Health-related Quality of Life (HRQOL) in Children Following Hemispherectomy for Intractable Epilepsy

Health-related quality of life (HRQOL) is an important outcome measure in clinical research. Given the psychosocial and behavioral difficulties associated with pediatric epilepsy, evaluating HRQOL in this patient population is of particular importance. Though HRQOL has been examined in pediatric patients receiving focal resection or pharmacological (antiepileptic drug; AED) treatment, it has not been assessed in patients receiving hemispherectomy (HE) for intractable epilepsy. The current study evaluated HRQOL in a sample of pediatric HE cases (N=26) using previously validated questionnaires relative to surgical (N=30) and nonsurgical (N=84) comparison groups. Compared with focal resection and nonsurgical patients, parents of children who received HE reported similar levels of HRQOL. In surgical cases, worse HRQOL was correlated with residual seizure frequency. In both surgical and nonsurgical cases, female gender, higher AED load, and lower functional independence predicted worse HRQOL. Interestingly, HE status (i.e., having undergone HE) predicted fewer epilepsy-related limitations. Consistent with previous findings, AED load, in addition to lower functional abilities, appear particularly detrimental to life quality in pediatric epilepsy. HE, however, is not associated with increased risk for poor HRQOL. When considered in light of the multiple, significant risk factors for poor outcome associated with HE, children who undergo the procedure fare surprisingly well.