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Kotas D, Zhao H, Turella J, Kasoff WS. Post-Traumatic Epilepsy: Observations from an Urban Level 1 Trauma Center. Neurol Int 2024; 16:845-852. [PMID: 39195565 DOI: 10.3390/neurolint16040063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
There are approximately 2.5 million cases of traumatic brain injury (TBI) in the U.S. each year. Post-traumatic epilepsy (PTE), a sequela of TBI, has been shown to occur in approximately 15% of TBI patients. Pre-disposing risk factors for the development of PTE include severe TBI and penetrating head injury. PTE is associated with poor functional outcomes, increased negative social factors, and mental illness. We conducted a retrospective chart review with a 5-year timeframe at an urban Level 1 Trauma Center. Patients with ICD-10-CM codes associated with TBI were identified. Patients were coded as TBI with or without PTE by the presence of codes associated with PTE. Datapoints collected included risk factors for PTE and encounters with neurologists. A total of 1886 TBI patients were identified, with 178 (9.44%) classified as TBI with PTE. The most significant risk factor associated with PTE was severe brain injury, with an odds ratio (OR) of 2.955 (95% CI [2.062,4.236]; p < 0.0001). Only 19 of 178 patients (10.7%) visited a neurologist beyond 6 months after TBI. Our results suggest the presence of a significant population of patients with PTE and the need for better follow-up.
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Affiliation(s)
- Daniel Kotas
- Department of Neurosurgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Center for Biostatistics and Epidemiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - John Turella
- Center for Biostatistics and Epidemiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Willard S Kasoff
- Department of Neurosurgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
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2
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Lorkiewicz SA, Modiano YA, Miller BI, Van Cott AC, Haneef Z, Sullivan-Baca E. The neuropsychological presentation of women with epilepsy: Clinical considerations and future directions. Clin Neuropsychol 2024; 38:1382-1408. [PMID: 37993977 DOI: 10.1080/13854046.2023.2283937] [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: 07/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Objective: Cognitive, mood, and behavioral changes are common among persons with epilepsy (PWE), resulting in a complex neuropsychological presentation. Women with epilepsy (WWE) represent a distinct cohort within the broader epilepsy population due to sex and gender-specific factors impacting epilepsy semiology and treatment. However, unique neuropsychological profiles among WWE have not been established. This narrative review aims to further define neuropsychological correlates in WWE and promote meaningful discussion related to enhancing the provision of neuropsychological care within this clinical population. Method: Current literature in PWE examining differences in cognitive function, mental health, and quality of life (QoL) between women and men was critically reviewed, emphasizing considerations for neuropsychological practice. Results: WWE demonstrate a preservation of verbal learning and memory compared to men both pre- and post-surgically, with sex-based, neurobiological mechanisms likely contributing to this association. WWE also have elevated risk for affective disorder psychopathology, suicidality, and traumatic experiences. Epidemiology related to psychotic and bipolar spectrum disorders is less clear, and findings are mixed regarding sex-specific behavioral side effects of antiseizure and psychotropic medication. Finally, hormonal and obstetric factors are highlighted as important contributors to neuropsychological symptoms in WWE, with elevated risk for low QoL and increased stigma associated with greater medical and psychiatric comorbidities compared to men. Conclusions: While emerging literature has begun to characterize the neuropsychological presentation of WWE, future research is needed to define sex and gender differences in neuropsychological sequalae among PWE to ensure consistency and quality of care for WWE.
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Affiliation(s)
| | - Yosefa A Modiano
- Neurosciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Brian I Miller
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Anne C Van Cott
- Neurology Division, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zulfi Haneef
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
- Epilepsy Centers of Excellence, Veteran's Health Administration, USA
| | - Erin Sullivan-Baca
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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3
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Pellinen J, Foster EC, Wilmshurst JM, Zuberi SM, French J. Improving epilepsy diagnosis across the lifespan: approaches and innovations. Lancet Neurol 2024; 23:511-521. [PMID: 38631767 DOI: 10.1016/s1474-4422(24)00079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024]
Abstract
Epilepsy diagnosis is often delayed or inaccurate, exposing people to ongoing seizures and their substantial consequences until effective treatment is initiated. Important factors contributing to this problem include delayed recognition of seizure symptoms by patients and eyewitnesses; cultural, geographical, and financial barriers to seeking health care; and missed or delayed diagnosis by health-care providers. Epilepsy diagnosis involves several steps. The first step is recognition of epileptic seizures; next is classification of epilepsy type and whether an epilepsy syndrome is present; finally, the underlying epilepsy-associated comorbidities and potential causes must be identified, which differ across the lifespan. Clinical history, elicited from patients and eyewitnesses, is a fundamental component of the diagnostic pathway. Recent technological advances, including smartphone videography and genetic testing, are increasingly used in routine practice. Innovations in technology, such as artificial intelligence, could provide new possibilities for directly and indirectly detecting epilepsy and might make valuable contributions to diagnostic algorithms in the future.
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Affiliation(s)
- Jacob Pellinen
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Emma C Foster
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jo M Wilmshurst
- Red Cross War Memorial Children's Hospital and University of Cape Town Neuroscience Institute, Cape Town, South Africa
| | - Sameer M Zuberi
- Royal Hospital for Children and University of Glasgow School of Health & Wellbeing, Glasgow, UK
| | - Jacqueline French
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
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4
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Ernawati I, Yasin NM, Setyopranoto I, Ikawati Z. Effect of Mobile Health Applications on Improving Self-Management Knowledge and Seizure Control in Epilepsy Patients: A Scoping Review. Healthc Inform Res 2024; 30:127-139. [PMID: 38755103 PMCID: PMC11098771 DOI: 10.4258/hir.2024.30.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Mobile health app-based interventions are increasingly being developed to support chronic disease management, particularly for epilepsy patients. These interventions focus on managing stress, monitoring drug side effects, providing education, and promoting adherence to medication regimens. Therefore, this scoping review aims to assess how mobile health applications improve epilepsy patients' knowledge and seizure control, and to identify the features of these apps that are frequently used and have proven to be beneficial. METHODS This scoping review was conducted using scientific databases such as ScienceDirect, PubMed, and Google Scholar, adhering to the Joanna Briggs Institute guidelines. The review framework consisted of five steps: identifying research questions, finding relevant articles, selecting articles, presenting data, and compiling the results. The literature search included all original articles published in English from 2013 to 2023. RESULTS Among six articles that discussed mobile applications for epilepsy patients, all featured similar functionalities, including education on epilepsy management and seizure monitoring. Four of the articles highlighted behavioral interventions, such as reminder systems, designed to improve medication adherence. The remaining two articles focused on a side-effect reporting system that enabled doctors or health workers to evaluate and regularly monitor adverse effects. CONCLUSIONS This scoping review reveals that mobile health applications employing a combination of educational and behavioral interventions for epilepsy patients significantly improve knowledge about patient self-management and medication adherence. These interventions can prevent seizures, increase awareness, enable better activity planning, improve safety, and reduce the frequency of seizures and side effects of antiepileptic drugs.
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Affiliation(s)
- Iin Ernawati
- Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
- Akademi Farmasi Surabaya, Surabaya,
Indonesia
| | - Nanang Munif Yasin
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
| | - Ismail Setyopranoto
- Department of Neurology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta,
Indonesia
| | - Zullies Ikawati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
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Alkoblan FI, Alsoadan MM, Alhajri AA, Almousa MM, Alsalamah FS, Kazi A, Bashiri FA, Aljafen B. Social Anxiety, Social Support, and Quality of Life in Patients With Epilepsy at a Tertiary Care Hospital in Saudi Arabia. Cureus 2023; 15:e45447. [PMID: 37859891 PMCID: PMC10583124 DOI: 10.7759/cureus.45447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/21/2023] Open
Abstract
Objectives The objectives of this study were to measure the prevalence of social anxiety disorder and its association with quality of life (QoL) in patients with epilepsy (PWE) in King Khalid University Hospital, Riyadh City, Saudi Arabia. Methodology A self-administrated, online, questionnaire-based, cross-sectional study was conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia on PWE 18 years of age and above from February 2021 to January 2022. Social anxiety and the five domains of QoL were measured using the validated Arabic versions of the Liebowitz social anxiety scale and European quality-of-life 5-dimensions 3-levels (EQ-5D-3L), respectively. Information was collected on sociodemographic characteristics, social support, and adverse life events. Results This study included 246 patients, of which approximately 25% and 15% had mild/moderate and severe/very severe levels of social anxiety, respectively. Severe social anxiety was significantly associated with poor QoL domains, namely, restricted mobility (2.65 [1.00, 6.99]), inability to perform usual activities (3.88 [1.61, 9.36]), pain or discomfort (3.21 [1.38, 7.48]), and anxiety and depression (5.77 [2.45, 13.61]). Similarly, the lack of social support was also significantly associated with poor QoL, such as restricted mobility (2.42 [1.12, 5.22]), restricted self-care (3.64 [1.18, 11.17]), inability to perform usual activities (2.86 [1.42, 5.75]), pain/discomfort (2.53 [1.38, 4.66]), and anxiety and depression (1.93 [1.04, 3.57]). Females showed higher odds for restricted mobility (2.79 [1.29, 6.03]) and low education with limited self-care (7.38 [1.49, 36.71]). Conclusion Patients with epilepsy reported high levels of social anxiety that have a negative effect on their QoL. Healthcare providers should be able to provide counseling to the patient and their family members. In addition, social support is important to improve their mobility and socialization with friends and neighbors.
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Affiliation(s)
| | | | | | | | | | - Ambreen Kazi
- Princess Nora Bent Abdullah Research Chair for Women's Health Research, Deanship of Scientific Research, King Saud University, Riyadh, SAU
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, SAU
| | - Fahad A Bashiri
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, SAU
| | - Bandar Aljafen
- Division of Neurology, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, SAU
- College of Medicine, Dar Al Uloom University, Riyadh, SAU
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6
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Lalatović S, Milovanović M, Krstić N. Stigma and its association with health-related quality of life in adults with epilepsy. Epilepsy Behav 2022; 135:108874. [PMID: 35973375 DOI: 10.1016/j.yebeh.2022.108874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the presence of felt and enacted stigma in people with epilepsy (PWE), members of a self-governing epilepsy organization and to evaluate the influence of both types of stigma on health-related quality of life (HRQoL) in PWE. METHODS Participants were 55 PWE (age range: 18-53 years), members of a non-governmental organization (further "NGO"). The sociodemographic and epilepsy-related variables were collected through structured interviews designed for the purpose of the study. Felt stigma was assessed with the Epilepsy Stigma Scale (ESS) and enacted stigma with the Questionnaire for episodes of discrimination against PWE. Quality of Life in Epilepsy Inventory (QOLIE-31) (Serbian version) was used for the evaluation of HRQoL. RESULTS The mean ESS score was 33.93 ± 14.50. Felt stigma was significantly associated with the male gender and the number of antiepileptic drugs (AEDs). Participants' mean score on the Questionnaire for episodes of discrimination was 2.80 ± 2.78. Enacted stigma was significantly correlated with male gender and number of AEDs, as well as with older age/longer duration of the disorder. Felt stigma scores were positively correlated with enacted stigma scores (p < 0.001), but only felt stigma scores were negatively related to QOLIE-31 overall score (p = 0.01). The combination of AEDs, seizure frequency, and felt stigma best explained the HRQoL in PWE (p < 0.001). CONCLUSION Felt and enacted stigma are moderately related, but only felt stigma appears to be a significant predictor of the deteriorating HRQoL in this sample. Interventions targeting felt stigma should be considered a part of comprehensive epilepsy care as well as educating the wider community about epilepsy.
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Affiliation(s)
- Staša Lalatović
- Faculty of Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, 11000 Belgrade, Serbia.
| | - Maja Milovanović
- Faculty of Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, 11000 Belgrade, Serbia; Department for Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Milana Kašanina 3, 11000 Belgrade, Serbia.
| | - Nadežda Krstić
- Faculty of Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, 11000 Belgrade, Serbia.
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Ogawa M, Fujikawa M, Tasaki K, Jin K, Kakisaka Y, Nakasato N. Development and validation of the Japanese version of the Epilepsy Stigma Scale in adults with epilepsy. Epilepsy Behav 2022; 134:108832. [PMID: 35863139 DOI: 10.1016/j.yebeh.2022.108832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Self-stigma is considered to have immensely negative influences on the living and psychological states in patients with epilepsy. Understanding the stigma experienced by patients with epilepsy is essential considering its negative impact on their treatment and quality of life (QOL). However, few sufficiently validated self-report instruments are available to evaluate self-stigma in patients with epilepsy. The Epilepsy Stigma Scale (ESS) is one of the most commonly used self-reported questionnaires available to evaluate self-stigma in patients with epilepsy. The present study translated the ESS into Japanese to validate the Japanese version of the ESS (ESS-J) in Japanese adults with epilepsy. METHODS The study included 338 patients with epilepsy (166 men, aged 18-75 years) who underwent comprehensive assessment including long-term video-electroencephalography monitoring, neuroimaging studies, and neuropsychological and psychosocial assessments in the Tohoku University Hospital Epilepsy Monitoring Unit. This study consisted of two phases: (1) translation of the ESS into Japanese using the back-translation technique; and (2) statistical analysis of the ESS-J to evaluate the factor structure, reliability, and validity. RESULTS The 2-factor model achieved acceptable fit to the data: χ2 = 161.27, df = 34, p < 0.01, comparative fit index = 0.929, root mean square error of approximation = 0.105, standardized root mean squared residual = 0.047, Akaike's information criterion = 203.27 and, Bayesian information criterion = 283.56. These two subscales were named enacted stigma and felt stigma based on the theoretical model of self-stigma. We found the ESS-J to have acceptable internal consistency as follows: enacted (7 items; α = 0.88) and felt stigma subscale (3 items; α = 0.82). The concurrent validity was confirmed by adequate correlation with other related instruments. Both enacted and felt stigma had positive and moderate correlations with depression as measured by the Neurological Disorders Depression Inventory for Epilepsy (r = 0.44, p < 0.01; r = 0.41, p < 0.01, respectively) and with anxiety as measured by the Generalized Anxiety Disorder -7 (r = 0.48, p < 0.01; r = 0.38, p < 0.01, respectively). CONCLUSION The ESS-J demonstrated acceptable validity and reliability. The present study provided preliminary evidence about the psychometric properties of the ESS-J, indicating the reliable factorial structure, adequate internal consistency, and satisfactory construct and concurrent validity. Measurement of the two types of self-stigma may offer a useful tool for clinical interpretation of patients' psychological state throughout epilepsy care, and as one of the patient-reported outcomes in QOL research.
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Affiliation(s)
- Maimi Ogawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mayu Fujikawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Katsuya Tasaki
- Department of International Communication, Aoyama Gakuin University, Tokyo, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Abstract
Caitríona Cox and Zoë Fritz argue that outdated medical language that casts doubt, belittles, or blames patients jeopardises the therapeutic relationship and is overdue for change
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Affiliation(s)
- Caitríona Cox
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Zoë Fritz
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
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Samanta D, Elumalai V, Hoyt ML, Modi AC, Sajatovic M. A qualitative study of epilepsy self-management barriers and facilitators in Black children and caregivers in Arkansas. Epilepsy Behav 2022; 126:108491. [PMID: 34929473 PMCID: PMC8764703 DOI: 10.1016/j.yebeh.2021.108491] [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: 10/15/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To identify facilitators and barriers of epilepsy self-management practices among Black children and caregivers. METHODS Qualitative semi-structured in-depth interviews were conducted with 11 child-caregiver dyads (11 children with epilepsy and 11 caregivers). A deductive-inductive analysis was undertaken to describe the range of barriers and facilitators significant to participants. RESULTS The barriers and facilitators were classified into 3 management themes: epilepsy-specific knowledge and information, treatment, and lifestyle. Within these themes, several important subthemes were identified. Two subthemes related to knowledge barriers emerged: children and caregivers' limited understanding and retention of complex written and spoken information and variable training and confidence in seizure first-aid. In contrast, facilitators for introducing and encouraging access to epilepsy self-management concepts were participants' eagerness to learn about this topic and a keen interest in using educational materials enriched with visual aids on a phone platform as an adjunct to in-person education. The second theme revealed various practical barriers to optimum treatment adherence, including mistrust of the healthcare system. In comparison, caregivers' collaborative approach and innovative strategies were identified as facilitators for treatment adherence. Finally, the lifestyle management barriers included a lack of defined processes to adopt healthy behaviors and challenges with disclosing epilepsy. Facilitators of this theme were comprised of building a team around the child to foster wellbeing and making healthy habits a fun and joyful experience for children. DISCUSSION Qualitative evidence in this study highlights caregivers' mistrust in the healthcare system and the lack of community support. Culturally competent interventions may improve access to and quality and utilization of self-management programs in Black children and families while reducing disparities.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Vimala Elumalai
- Division of Neurology, Arkansas Children’s Hospital, United States of America
| | - Megan Leigh Hoyt
- Division of Neurology, Arkansas Children’s Hospital, United States of America
| | - Avani C. Modi
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio,Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Mireia G, Lara GL, Marta J, Marina HS, Alejandra F, Jordi C, Luis BJ, Laia GL. Clinical factors associated with work disability in epilepsy: A cross-sectional study at a tertiary referral hospital. Epilepsy Behav 2021; 124:108310. [PMID: 34530247 DOI: 10.1016/j.yebeh.2021.108310] [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: 06/02/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The impact of epilepsy on work disability remains unclear. The aim of this study was to determine the percentage of patients with epilepsy who are unemployed or on temporary or permanent disability leave and to analyze associated clinical factors. METHODS We performed an observational cross-sectional study of consecutively recruited patients with epilepsy seen at a specialized epilepsy unit or admitted to the epilepsy monitoring unit of a tertiary referral hospital. We analyzed the percentage of patients who were actively employed, unemployed, and on temporary or permanent disability leave. The groups were compared for sociodemographic data (age, sex, marital status, and type of work), clinical data (type of epilepsy, disease duration, monthly seizure frequency, and presence of anxiety or depression), treatment-related factors, and quality of life. RESULTS We included 742 patients (53% male, mean age 44.3 ± 13.7 years old): 40.5% were employed, 29.2% were unemployed, 19% were on temporary disability leave, and 11.1% had a permanent work disability. Depressive symptoms and poorer quality of life were associated with unemployment (OR 2.3, p = 0.02 and OR 1.8, p = 0.01), temporary disability leave (OR 1.4, p = 0.05 and OR 1.7, p = 0.02), and permanent work disability (OR 1.9, p = 0.01 and OR 2.2, p = 0.01). Low-skilled work was also predictive of unemployment (OR 1.9, p = 0.04), temporary disability leave (OR 2.8, p = 0.03), and permanent work disability (OR 1.7, p = 0.04). A higher monthly seizure frequency was associated with permanent work disability (OR 2.01, p = 0.02). CONCLUSION Less than 50% of patients with epilepsy in our setting are working. Factors associated with unemployment and work disability are a higher frequency of seizures, low-skilled work, depressive symptoms, and poor quality of life.
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Affiliation(s)
- Gea Mireia
- Department of Neurosciences, Hospital Germans Trias I Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Grau-López Lara
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jiménez Marta
- Department of Neurosciences, Hospital Germans Trias I Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Hernández-Stahl Marina
- Department of Neurosciences, Hospital Germans Trias I Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Fumanal Alejandra
- Department of Neurosciences, Hospital Germans Trias I Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Ciurans Jordi
- Department of Neurosciences, Hospital Germans Trias I Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Becerra Juan Luis
- Department of Neurosciences, Hospital Germans Trias I Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Grau-López Laia
- Department of Neurosciences, Hospital Germans Trias I Pujol, C/ Canyet s/n, 08916 Badalona, Spain.
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11
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Henning O, Buer C, Nakken KO, Lossius MI. People with epilepsy still feel stigmatized. Acta Neurol Scand 2021; 144:312-316. [PMID: 33961282 DOI: 10.1111/ane.13449] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/12/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Those affected with epilepsy have long been subject to stigmatization. This may have manifold negative effects, for example social isolation, low self-esteem, reduced quality of life and worsening of seizures. In Norway educational programs have been arranged at the National Centre for Epilepsy, aiming at reducing stigma and shame associated with epilepsy, and thereby increase the quality of life for those affected and their families. Thus, we wanted to explore the extent of self-reported perceived stigma and experienced discrimination in a Norwegian cohort with epilepsy. MATERIALS AND METHODS We conducted a web-based questionnaire survey in Norway. Participants were asked to provide background and epilepsy-related information. In addition, they were encouraged to answer questions regarding felt stigmatization in different situations and to rate stigma according to the Jacoby stigma scale. RESULTS Of 1182 respondents, 56% reported to have felt being stigmatized, and 35% reported to have experienced discrimination solely on the ground of the disease. 70% of respondents reported at least one type of perceived or experienced stigma. After controlling for gender, age, perceived depression and seizure freedom, reports of experienced stigmatization was a statistically significant independent predictor for reduced quality of life. CONCLUSIONS A considerable proportion of people with epilepsy in Norway feel stigmatized and/or subject to discrimination, which negatively affects their quality of life.
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Affiliation(s)
- Oliver Henning
- National Centre for Epilepsy Division of Clinical Neuroscience Oslo University Hospital Oslo Norway
| | | | - Karl O. Nakken
- National Centre for Epilepsy Division of Clinical Neuroscience Oslo University Hospital Oslo Norway
| | - Morten I. Lossius
- National Centre for Epilepsy Division of Clinical Neuroscience Oslo University Hospital Oslo Norway
- Clinical Medicine University of Oslo Oslo Norway
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12
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Blixen C, Ghearing G, Wade O, Colon-Zimmerman K, Tyrrell M, Sajatovic M. Engaging stakeholders in the refinement of an evidence-based remotely delivered epilepsy self-management program for rural populations. Epilepsy Behav 2021; 118:107942. [PMID: 33845345 PMCID: PMC8107125 DOI: 10.1016/j.yebeh.2021.107942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
A growing body of research supports self-management approaches that can improve outcomes in people living with epilepsy (PLWE). An evidence-based remotely delivered self-management program (SMART) that was successfully delivered in an urban/suburban setting has the potential to be particularly helpful to PLWE who live in rural communities, where heavy stigma burden and limited access to healthcare is common. In this Phase 1 exploratory study, focus groups of key rural stakeholders (PLWE, family members, care providers) were used to: (1) gather information on factors that may impede or facilitate participation in SMART and (2) elicit overall perceptions of the program, as well as suggestions and feedback for refining it for implementation in Phase 2 of the randomized controlled study (RCT). Qualitative data analysis revealed that focus group participants identified geographic and social isolation, and the more limited access to epilepsy care, as the major barriers to epilepsy self-management for rural populations. However, they felt strongly that SMART could fill an epilepsy care gap in rural communities, and provided suggestions for recruitment and retention strategies of subjects, as well as improvement/modifications to the program curriculum for the Phase 2 RCT.
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Affiliation(s)
- Carol Blixen
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Gena Ghearing
- Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Owen Wade
- Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Kari Colon-Zimmerman
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Maegan Tyrrell
- Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Martha Sajatovic
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Psychiatry & Neurology and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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