Sleep profiles in epilepsy patients undergoing monotherapy and polytherapy: A comparative cross-sectional study

OBJECTIVE

Sleep disturbances commonly reported among epilepsy patients have a reciprocal relationship with the condition; While epilepsy and anti-seizure medications (ASMs) can disrupt sleep structure, disturbed sleep can also exacerbate the frequency of seizures. This study explored subjective sleep disturbances and compared sleep profiles in patients who underwent ASM monotherapy and polytherapy.

METHODS

We enrolled 176 epilepsy patients who completed a structured questionnaire containing demographic and clinical information and the Persian versions of the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Patient Health Questionnaire-9 (PHQ-9) to evaluate sleep quality, insomnia, excessive daytime sleepiness (EDS), and depressive symptoms, respectively. Chi-square and Mann-Whitney U tests were employed to analyze the association between variables, and logistic regression analysis was conducted to identify factors predicting sleep disturbances.

RESULTS

Comparative analysis of mono/polytherapy groups revealed a significantly higher prevalence of insomnia and EDS among patients on polytherapy compared to monotherapy. However, no significant difference was found in sleep quality between the two groups. Logistic regression analysis revealed that a depressive mood serves as a robust predictor for sleep issues, whereas treatment type did not emerge as an independent predictor of sleep disturbances.

CONCLUSION

Our findings suggest that an increased number of ASMs does not inherently result in a higher incidence of sleep issues. Therefore, multiple ASMs may be prescribed when necessary to achieve improved seizure control. Furthermore, this study underscores the importance of comprehensive management that addresses seizure control and treating affective symptoms in individuals with epilepsy.

Machine Learning for prediction of violent behaviors in schizophrenia spectrum disorders: a systematic review

Background

Schizophrenia spectrum disorders (SSD) can be associated with an increased risk of violent behavior (VB), which can harm patients, others, and properties. Prediction of VB could help reduce the SSD burden on patients and healthcare systems. Some recent studies have used machine learning (ML) algorithms to identify SSD patients at risk of VB. In this article, we aimed to review studies that used ML to predict VB in SSD patients and discuss the most successful ML methods and predictors of VB.

Methods

We performed a systematic search in PubMed, Web of Sciences, Embase, and PsycINFO on September 30, 2023, to identify studies on the application of ML in predicting VB in SSD patients.

Results

We included 18 studies with data from 11,733 patients diagnosed with SSD. Different ML models demonstrated mixed performance with an area under the receiver operating characteristic curve of 0.56-0.95 and an accuracy of 50.27-90.67% in predicting violence among SSD patients. Our comparative analysis demonstrated a superior performance for the gradient boosting model, compared to other ML models in predicting VB among SSD patients. Various sociodemographic, clinical, metabolic, and neuroimaging features were associated with VB, with age and olanzapine equivalent dose at the time of discharge being the most frequently identified factors.

Conclusion

ML models demonstrated varied VB prediction performance in SSD patients, with gradient boosting outperforming. Further research is warranted for clinical applications of ML methods in this field.

Brain structural and functional abnormalities in patients with tension-type headache: A systematic review of magnetic resonance imaging studies

Tension-type headache (TTH) stands as the most prevalent form of headache, yet an adequate understanding of its underlying mechanisms remains elusive. This article endeavors to comprehensively review structural and functional magnetic resonance imaging (MRI) studies investigating TTH patients, to gain valuable insights into the pathophysiology of TTH, and to explore new avenues for enhanced treatment strategies. We conducted a systematic search to identify relevant articles examining brain MRI disparities between TTH individuals and headache-free controls (HFC). Fourteen studies, encompassing 312 diagnosed TTH patients, were selected for inclusion. Among these, eight studies utilized conventional MRI, one employed diffusion tensor imaging, and five implemented various functional MRI modalities. Consistent findings across these studies revealed a notable increase in white matter hyperintensity (WMH) in TTH patients. Furthermore, the potential involvement of the specific brain areas recognized to be involved in different dimensions of pain perception including cortical regions (anterior and posterior cingulate cortex, prefrontal cortex, anterior and posterior insular cortex), subcortical regions (thalamus, caudate, putamen, and parahippocampus), cerebellum in TTH pathogenesis was identified. However, no significant association was established between TTH and intracranial abnormalities or total intracranial volume. In conclusion, these findings support the hypotheses regarding the role of central mechanisms in TTH pathophysiology and offer probable brain regions implicated in these mechanisms. Due to the scarce data on the precise role of these regions in the TTH, further preclinical and clinical investigations should be done to advance our knowledge and enhance targeted therapeutic options of TTH.

Examining the validity and reliability of the Persian version of the MiND-B questionnaire in ALS patients

BACKGROUND

In addition to affecting the nerves and muscles, amyotrophic lateral sclerosis (ALS) disease also affects the behavior and cognition of patients. In this study, we examine the validity and reliability of the Persian version of Motor Neuron Disease Behavioral instrument (MiND-B) questionnaire to investigate behavioral changes in Persian-speaking ALS patients.

METHODS

Forty-six Persian-speaking patients with ALS filled out the MiND-B questionnaire. Then, the overall scores and each of the domains of this questionnaire were statistically analyzed.

RESULTS

Cronbach's alpha coefficient was calculated .70 for the whole questionnaire. To check the validity of the questionnaire, the correlation of its scores with the Edinburgh Cognitive and Behavioral ALS screen (ECAS-A) questionnaire was taken, and this correlation was significant (p = .038).

CONCLUSION

The findings of this study show that the Persian version of the MiND-B questionnaire has the necessary validity and reliability to investigate behavioral changes in Persian-speaking patients with ALS.

Assessment of quality of life in menopausal periods: a population study in kashan, iran

BACKGROUND

Menopause is a physiological process in women's life. The aim of this study was to assess QOL and related factors among menopausal women in Kashan city in Iran.

METHODS

Seven hundred women aged 40-60 years were assessed using cluster sampling. Women with mental and physical problems or systemic diseases were excluded. Data were collected by standard questionnaire of quality of life in the menopause.

RESULTS

The mean menopausal age was 47.6±4.1 years. 55.6% of women had been postmenopausal for less than 5 years. The overall mean scores obtained for each domain was 2.82±1.64 for vasomotor, 2.71±1.2 for psychosocial, 2.46±0.99 for physical and 2.89±1.73 for sexual domains.

CONCLUSION

Age, working status, physical activity, educational level, duration of menopause, income satisfaction, marriage satisfaction and the number of children in those living with family had influence on quality of life in menopausal women.

The relationship between women's health beliefs and their participation in screening mammography

Breast cancer is the most common type of cancer in women. Early diagnosis of this disease can reduce mortality significantly and will promote women's quality of life. Changes in the women's beliefs and attitudes are necessary to encourage them to undergo screening mammography. To make this change happen, understanding their health beliefs is important. This attempt is to determine the relationship between women's health belief of city of Kerman with their participation in mammography on the basis of health belief model in the year 2005-2006. This study was an experimental-control one in which the main independent variable was health belief including different dimensions such as perceived sensitivity, perceived intensity, perceived barriers, perceived benefits, "cues to actions" and self-efficacy. Participation in the mammography was taken as the dependent variable. Two samples consisting of 148 women who had and 148 women who had not underwent mammography were selected. Data were collected through questionnaires and were analyzed by SPSS=12 software. The result of this study showed that women's health belief in some dimensions of health belief model such as perceived benefits of mammography use, the presence of cues to action in mammography use is associated with having mammography. Moreover the total score of mammography group was more than the score of the group without the mammography. When the two groups were compared in terms of demographic data, experimental group showed significant statistical differences with regard to age, benign breast mass and family history of breast cancer. (P, 0001)Understanding the benefits and advantages of mammography and cues to action will increase women's adherence toward doing it. It is of great importance to better realize breast cancer screening behaviors and factors influencing it. It is also necessary to recognize the factors affecting health professionals' and particularly nurses' use of mammography.