The strategies for coping with stress of epilepsy patients

Neurological Sciences - This study aims to compare the styles of coping with stress between patients with epilepsy and healthy individuals and to examine the effects of clinical features on methods...     

Coping with epilepsy: the effect of coping styles on self-perceived seizure severity and psychological complaints.

Having a chronic condition like epilepsy imposes a serious burden for the sufferer. This is reflected in a higher level of psychological complaints. The way in which one copes with epilepsy is an important determinant in this level of complaints and in the self-perceived severity of the seizures. In this paper the relation between coping styles and self-perceived seizure severity as well as psychological complaints, is studied. A group of epilepsy patients was asked to fill out a number of questionnaires on coping styles, self-perceived seizure severity and psychological complaints. The patients with epilepsy were seen to have coping styles different from the general population: in general they tended to use less active strategies in coping with their problems. A less active coping style was found to be related to a higher self-perceived seizure severity. Other epilepsy-related variables, like seizure frequency, showed no relation with self-perceived seizure severity. This could mean that stimulating patients to use active coping styles results in a decrease in self-perceived seizure severity.     

Stressful life event appraisal and coping in patients with psychogenic seizures and those with epilepsy

Understanding stress and coping among individuals with psychogenic nonepileptic seizures (PNES) may have important treatment implications. 40 patients with PNES, 20 with epilepsy (EPIL), and 40 healthy control (HC) participants reported the frequency of various stressful life events (both positive and negative) and appraised the distress these events induced. They also described their habitual coping behaviors. PNES patients reported no more frequent stressful life events than EPIL patients or HC. In addition, the stressors they experienced are not objectively more severe. However, they reported more severe distress due to negative life events, especially in the domains of work, social functioning, legal matters, and health. PNES patients also engaged in less planning and active coping than HC. Neither of these two coping behaviors was associated with distress ratings. The PNES group did not engage in more denial than either group. However, greater denial among PNES patients was associated with greater perceived distress. Coping in PNES is characterized by elevated levels of perceived distress and fewer action strategies than are normally employed to reduce the impact of a stressor. These findings may inform cognitive behavioral therapy of PNES patients.     

癫 患儿家长特质应对方式调查分析简

目的调查研究癫痼患儿家长特质应对方式之特点,以了解其心理健康状况,为针对性心理行为干预提供依据。方法共225例癫痼患儿家长接受特质应对方式问卷（TCSQ）评价,从性别、工作压力等方面分析其特质应对方式特点。结果癫痼患儿家长消极应对和积极应对方式在性别、不同工作压力,以及新诊断与既往诊断之间存在差异（均P〈0．05）,男性和既往诊断患儿之家长对疾病的应对方式更积极,而工作压力大和新诊断患儿之家长应对方式消极;不同发作类型癫痫患儿之家长积极应对方式存在差异,以部分性发作型患儿之家长应对方式更积极（P〈0．05）。结论癫痫患儿家长特质应对方式有其特点,存在较多心理健康问题,临床上应针对性地进行心理行为干预,改善患儿家长心理状况。     

Adjustment in children with intractable epilepsy: importance of seizure duration and family factors

Seventy-five families of children with intractable epilepsy but without a severe learning disability (mean age 7 years 1 month, SD 2 years 6 months; range 2 to 12 years) who attended a regional paediatric neurology service, were surveyed. A postal questionnaire was used which included standardized measures of child and family adjustment; forty-eight families responded (64%; 31 males, 17 females). There was no significant difference between responders and non-responders in terms of age, sex, number of other chronic illnesses and disabilities, age at epilepsy diagnosis, seizure type, nor number of antiepileptic drugs currently prescribed (p > 0.05). The importance of including multidimensional measures of outcome was highlighted by the finding that epilepsy, pharmacological, and psychosocial factors were differentially associated with specific adjustment difficulties. Two factors appeared to be most pervasively implicated across a range of adjustment problems: frequency of rectal diazepam administration and family patterns of relating to each other (p < 0.05). It appeared that duration of seizures (as indicated by frequency of rectal diazepam administration), rather than the frequency of seizures per se, was more pernicious in terms of poor adjustment. Intrafamilial relations (degree of conflict/cohesion and soon) were not only associated with adjustment difficulties in the child, but also with the frequency of seizures themselves. Implications for psychological interventions in intractable epilepsy in childhood are highlighted.     

Analyzing depression coping strategies of patients with epilepsy: A preliminary study

PurposeTo determine whether individuals with epilepsy who are depressed have different coping reactions, such as increased use of disengagement-type coping reactions, compared to those who are not.MethodsWe surveyed 200 patients with epilepsy and obtained demographic and clinical information. We used the Neurological Institute Disorders Depression Inventory for Epilepsy (NIDDI-E) to determine those patients who had a major depression (NIDDI-E score >15) and administered the Quality of Life in Epilepsy-10 Inventory (QOLIE-10), Beliefs About Medicines Questionnaire-Specific, Sheehan Disability Scale, a screening question for health literacy (“How confident are you filling out medical forms by yourself?”), and the Brief Coping with Problems Experienced (Brief-COPE). Using univariate analysis, we determined those demographic and clinical variables that were associated with depression. We also determined the coping reactions more frequently utilized by individuals with depression, and using multivariate analysis, determined whether those coping reactions retained statistical significance. We performed subgroup analysis of depressed epilepsy patients to determine whether coping reactions they preferentially utilized were associated with seizure frequency and quality of life.ResultsSeventy-one patients had a major depression while 128 did not. On univariate analysis, not driving, not working, higher seizure frequency, experiencing convulsions, poorer quality of life, and higher disability scores were significantly associated with major depression. These individuals used denial more often as a coping reaction. On multiple linear regression, the association between the use of denial and being depressed retained statistical significance. The mean denial coping scores were higher among depressed patients with more frequent seizures. However, this did not reach statistical significance.ConclusionIndividuals with epilepsy who have a major depression utilize denial more often as a coping reaction. Realizing this is of value to caregivers as they help patients deal with their stressful situation. This also provides additional impetus to more effectively and aggressively treatment depression in the epilepsy population.     

Measuring coping in breast cancer.

The emotional distress associated with breast cancer varies between individual women. These variations may be accounted for by differences in cognitive and behavioural coping responses to diagnosis. This study has attempted to develop a reliable, situation-specific approach to the measurement of coping responses in women with breast cancer. It has adapted a general coping questionnaire and modified an interview-based schedule for coping with cancer. The strengths and weaknesses of the interview and self-report methods of assessment are highlighted. Consistent results from these complementary approaches have been obtained. Both indicate the extensive use of cognitive avoidance and positive reappraisal. It has been shown that the majority of patients use a wide repertoire of coping responses which challenges the notion of mutually exclusive coping styles. These measures may be employed to examine the relationship between women's thoughts and behaviours in response to the diagnosis and treatment of breast cancer and subsequent psychological outcome.     

MEG and EEG in epilepsy.

Both EEG and magnetoencephalogram (MEG), with a time resolution of 1 ms or less, provide unique neurophysiologic data not obtainable by other neuroimaging techniques. MEG has now emerged as a mature clinical technology. While both EEG and MEG can be performed with more than 100 channels, MEG recordings with 100 to 300 channels are more easily done because of the time needed to apply a large number of EEG electrodes. EEG has the advantage of the long-term video EEG recordings, which facilitates extensive temporal sampling across all periods of the sleep/wake cycle. MEG and EEG seem to complement each other for the detection of interictal epileptiform discharges, because some spikes can be recorded only on MEG but not on EEG and vice versa. Most studies indicate that MEG seems to be more sensitive for neocortical spike sources. Both EEG and MEG source localizations show excellent agreement with invasive electrical recordings, clarify the spatial relationship between the irritative zone and structural lesions, and finally, attribute epileptic activity to lobar subcompartments in temporal lobe and to a lesser extent in extratemporal epilepsies. In temporal lobe epilepsy, EEG and MEG can differentiate between patients with mesial, lateral, and diffuse seizure onsets. MEG selectively detects tangential sources. EEG measures both radial and tangential activity, although the radial components dominate the EEG signals at the scalp. Thus, while EEG provides more comprehensive information, it is more complicated to model due to considerable influences of the shape and conductivity of the volume conductor. Dipole localization techniques favor MEG due to the higher accuracy of MEG source localization compared to EEG when using the standard spherical head shape model. However, if special care is taken to address the above issues and enhance the EEG, the localization accuracy of EEG and MEG actually are comparable, although these surface EEG analytic techniques are not typically approved for clinical use in the United States. MEG dipole analysis is approved for clinical use and thus gives information that otherwise usually requires invasive intracranial EEG monitoring. There are only a few dozen whole head MEG units in operation in the world. While EEG is available in every hospital, specialized EEG laboratories capable of source localization techniques are nearly as scarce as MEG facilities. The combined use of whole-head MEG systems and multichannel EEG in conjunction with advanced source modeling techniques is an area of active development and will allow a better noninvasive characterization of the irritative zone in presurgical epilepsy evaluation. Finally, additional information on epilepsy may be gathered by either MEG or EEG analysis of data beyond the usual bandwidths used in clinical practice, namely by analysis of activity at high frequencies and near-DC activity.     

Effects of religiosity and religious coping on medication adherence and quality of life among people with epilepsy

The epidemiologic information demonstrates the importance of caring people with epilepsy (PWE). Indeed, the impaired quality of life (QoL) and medication nonadherence rate among PWE have been reported. However, religiosity and religious coping could be potential factors for clinicians to foster appropriate intervention on epileptic care. This study investigated two models to further understand the relationships between religiosity, religious coping (including positive and negative coping), medication adherence, and QoL in an Iranian sample with epilepsy. Eligible PWE (n = 760) completed the religiosity scale (Duke University Religion Index; DUREL) at baseline; the religious coping scale (Brief Religious Coping Scale; Brief RCOPE) one month later; the medication adherence scale (Medication Adherence Report Scale; MARS-5) two months later; and the QoL scale (Quality of Life in Epilepsy; QOLIE-31) twelve months later. Their antiepileptic drug serum level was measured during the period they completed the MARS. Through structural equation modeling (SEM), we found that religiosity directly correlated with negative religious coping and medication adherence, and indirectly correlated with medication adherence through negative religious coping. Both positive and negative religious coping directly correlated with medication adherence and QoL. Therefore, religiosity and religious coping may be determinants of medication adherence and QoL in PWE; health professionals may consider asking PWE if religion is important to them and how they use it to cope with their epilepsy.     

Spiritual/religious coping in patients with epilepsy: Relationship with sociodemographic and clinical aspects and quality of life

The relationship between headache and seizures is a complicated one, since these two conditions are related in numerous ways.Although the nature of this association is unclear, several plausible explanations exist: the two disorders coexist by chance; headache is part (or even the sole ictal phenomenon) of seizures or the post-ictal state; both disorders share a common underlying etiology; and epilepsy mimics the symptoms of migraine (as in benign childhood epilepsy).Seizures and headaches as well as their respective primary syndromes (epilepsy and headache/migraine) share several pathophysiological mechanisms. These mechanisms especially involve neurotransmitter and ion channel dysfunctions. Also, photosensitivity seems to play a role in the connection. In order to improve the care for patients with a clinical connection between migraine and epilepsy, it is necessary to try to understand more accurately the exact pathophysiological point of connection between these two conditions. Both experimental and clinical measures are required to better understand this relationship. The development of animal models, molecular studies defining more precise genotype/phenotype correlations, and multicenter clinical studies with revision of clinical criteria for headache/epilepsy-related disorders represent the start for planning future translational research.In this paper, we review the relationship between migraine and epilepsy in terms of epidemiology and pathophysiology with regard to translational research and clinical correlations and classification.This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”.     

Adjustment disorder in children and adolescents.

The literature on adjustment disorder in children and adolescents is reviewed to evaluate the empirical and conceptual basis of this disorder as defined in DSM-III-R, and to determine whether revisions, are indicated in DSM-IV. Existing studies suggest that adjustment disorder is a disorder of high prevalence in all settings, which carries significant morbidity and poor outcome in children and adolescents. Problems identified with the DSM-III-R definition include low reliability, the predominance of mixed rather than discrete symptom presentations in children and adolescents, and the persistence of symptoms in excess of 6 months in a significant number of cases.     

Homocysteine and bone loss in epilepsy.

Epidemiological studies reveal fracture incidence in epilepsy is twice that of the normal population. Much interest has been focused on Vitamin D, however, considering mixed results on non-enzyme inducing anti-epileptic drugs (AEDs) and bone mineral density (BMD) additional metabolic effects may be to blame. AEDs increase serum homocysteine (s-Hcy) by lowering blood folate levels. An association between elevated homocysteine, BMD and increased fracture incidence has been found in non-epilepsy populations. Additionally, folate and Vitamin B12 levels are independently related to bone mineral density in various non-epilepsy populations. This study supports previous research, which found elevated s-Hcy in subjects taking AEDs and that bone loss is related to the use of enzyme-inducing AEDs and changes in alkaline phosphatase. By one-way ANOVA, subjects on phenytoin monotherapy had significantly higher levels of s-Hcy than those on other AEDs (F=5.89, p=.016). Regression analyses revealed homocysteine, fracture history, length of years on AEDs, ethnicity were predictors of spine T scores. Weight and BMI were predictors of both BMD and DEXA T scores. Use of enzyme-inducing AEDs was a negative predictor of spine BMD and T scores, while phenytoin monotherapy was a positive predictor of spine BMD. Lamotrigine was found to be a negative predictor of spine T score. Ambulatory status, menopause and alcohol consumption were predictors of BMD but not T scores. In this study, persons with epilepsy who take nutritional supplementation have 25% lower s-Hcy levels than those who do not. Supplementation continues to be important in preventative epilepsy care.     

Depression in epilepsy. Significance and phenomenology

Depression is common in epileptics, but few studies of this relationship exist. We investigated the prevalence of depression in comparably disabled outpatients and its phenomenology in psychiatrically hospitalized inpatients. Fifty-five percent of 175 outpatient epileptics and 30% of 70 matched controls reported depression; 30% of epileptics vs 7% of controls reported prior suicide attempts. Epileptics were four times more likely to have been hospitalized for depression than nonepileptics. Twenty depressed epileptic inpatients were characterized by "endogenous" rather than "neurotic" features with more psychotic traits, paranoia, and underlying chronic dysthymia. Sixteen patients had complex partial seizures, and ten of 11 patients had a lateralized electroencephalographic focus lateralized to the left hemisphere. These results suggest a specific epileptic psychosyndrome due to limbic dysfunction.     

Folate and monoamine metabolism in epilepsy.

In 27 drug-treated epileptics there was a significant fall in serum, red cell and CSF folate levels compared with 15 untreated epileptics and 22 neurological controls. The 3 folate parameters were positively correlated with each other and negatively correlated with serum phenobarbitone, diphenylhydantoin and primidone. There was also a significant elevation of CSF 5-hydroxyindoleacetic acid (5HIAA) in the drug-treated epileptics; but this was not seen until "therapeutic" serum levels of phenobarbitone and diphenylhydantoin had been achieved and was most marked in clinically intoxicated patients. Similar trends were observed in CSF homovanillic acid (HVA). CSF 5HIAA and HVA were positively correlated with each other, especially in the drug-treated patients, in whom both amine metabolites were also negatively correlated with CSF folate. A possible relationship between folate and monoamine metabolism is discussed with particular reference to the antiepileptic and toxic effects of phenobarbitone, diphenylhydantoin and primidone.     

Vigabatrin and lamotrigine in refractory epilepsy.

Epilepsy arises from an imbalance of inhibitory and excitatory influences in the brain. Vigabatrin (VIG) decreases the breakdown of the inhibitory neurotransmitter gamma-aminobutyric acid, whereas lamotrigine (LTG) reduces presynaptic excitatory amino acid release. 22 patients with refractory epilepsy, treated with an anticonvulsant regimen containing VIG, entered a balanced, double blind, placebo controlled, crossover trial of additional LTG. Treatment periods of 12 weeks (25 mg, 50 mg, 100 mg LTG twice daily for four weeks at each dose, and matched placebo) were followed by wash out intervals of four weeks. 14 of the 20 patients completing the study improved, resulting in a significant fall in seizure days and numbers. Analysis of seizure type confirmed a beneficial effect on partial and secondary generalised tonic-clonic seizures. At the highest LTG dose (200 mg daily) there was a median fall of 37% in seizure count with nine (45%) patients reporting > 50% reduction. Three of these patients were seizure free during this month of treatment. Side effects were minimal throughout the study. Concentrations of other antiepileptic drugs, including those of carbamazepine 10,11-epoxide, were not modified by LTG. This study suggests a substantial efficacy for a regimen containing VIG and LTG. Combinations of drugs with complementary modes of action may provide a rational pharmacological approach to the management of refractory epilepsy.     

Adjustment to chronic pain: The role of pain acceptance,coping strategies,and pain-related cognitions

Background: Previous research has found that acceptance of pain is more successful than coping variables in predicting adjustment to pain.Purpose: To compare the influence of acceptance, pain-related cognitions and coping in adjustment to chronic pain.Methods: One hundred seventeen chronic pain patients attending the Clinical Pain Unit were administered a battery of questionnaires assessing pain acceptance, active and passive coping, pain-related cognitions, and adjustment.Results: The influence of acceptance, coping, and cognition on all the adjustment variables was considered simultaneously via Structural Equation Modeling using LISREL 8.30 software. A multigroup analysis showed that the male and female samples did not significantly differ regarding path coefficients. The final model showed that acceptance of pain determined functional status and functional impairment. However, coping measures had a significant influence on measures of emotional distress. Catastrophizing self-statements significantly influenced reported pain intensity and anxiety; resourcefulness beliefs had a negative and significant influence on depression.Conclusions: These findings suggest that acceptance may play a critical role in the maintenance of functioning and, with this aim, acceptance-based treatments are promising to avoid the development of disability. They also lend support to the role of control beliefs and of active coping to maintain a positive mood. Acceptance and coping are presented as complementary approaches.     

Seizure control and mortality in epilepsy.

Mortality rates are increased among people with epilepsy, and may be highest in those with uncontrolled seizures. Because epilepsy surgery eliminates seizures in some people, we used an epilepsy surgery population to examine how seizure control influences mortality. We tested the hypothesis that patients with complete seizure relief after surgery would have a lower mortality rate than those who had persistent seizures. Three hundred ninety-three patients who had epilepsy surgery between January 1986 and January 1996 were followed after surgery to assess long-term survival; 347 had focal resection or transection, and 46 had anterior or complete corpus callosotomy. A multivariate survival analysis was performed, contrasting survival in those who had seizure recurrence with survival of those who remained seizure free. Standardized mortality ratios and 95% confidence intervals were calculated. Overall, seizure-free patients had a lower mortality rate than those with persistent seizures. This was true for the subset of patients with localized resection or multiple subpial transection. No patients died among 199 with no seizure recurrence, whereas of 194 patients with seizure recurrence, 11 died. Six of the deaths were sudden and unexplained. Most patients who died had a substantial reduction in postoperative seizure frequency. The standardized mortality ratio for patients with recurrent seizures was 4.69, and the risk of death in these patients was 1.37 in 100 person-years, whereas among patients who became seizure free, there was no difference in mortality rate compared with the age- and sex-matched population of the United States. Elimination of seizures after surgery reduces mortality rates in people with epilepsy to a level indistinguishable from that of the general population, whereas patients with recurrent seizures continue to suffer from high mortality rates. This suggests that uncontrolled seizures are a major risk factor for excess mortality in epilepsy. Achieving complete seizure control with epilepsy surgery in refractory patients reduces the risk of death, so the long-term risk of continuing medical treatment appears to be higher than the risk of epilepsy surgery in suitable candidates.