Caregiver perceptions of seizure severity in pediatric epilepsy

Purpose:  Seizure severity has been investigated using multiple tools over the years, and its defining features continue to be debated. Severity ratings are necessary for medical, psychological, and epidemiologic investigations. Adults with epilepsy have been evaluated more than youth with epilepsy.
Methods:  Seizure severity was evaluated as part of a larger study that included youth and caregiver self-report measures of the emotional and social variables that occur in epilepsy.
Results:  The results indicate that a longer recovery time from the last seizure and a longer duration of seizure influence how severe a caregiver judges seizures. The usual elements such as type of epilepsy, frequency of seizures, and most recent seizure were not significantly related to severity rating. Behavior ratings were also not related to severity rating.
Discussion:  Clinicians often rely heavily on caregiver information during clinic visits to help inform treatment decisions; therefore, a standard measure of seizure severity from the caregivers' perception has clinical utility. Rather than assuming what makes a seizure severe to a parent, more research should be conducted on what elements contribute to severity, as judged by both the parent and youth.     

The effect of seizure severity on quality of life in epilepsy

Seizure severity is an important aspect of epilepsy. The relationship between seizure severity and quality of life in epilepsy, however, has been incompletely explored. With a data set of 118 women from the baseline phase of a clinical treatment trial, the relationship between seizure severity and aspects of quality of life was evaluated. Two domains of the Quality of Life in Epilepsy-31 (QOLIE-31) correlated highly significantly with seizure severity: Seizure Worry (r=-0.265, P=.004) and Social Functioning (r=-0.280, P=0.002). Two additional domains were significantly correlated: Overall Quality of Life (r=-0.210, P=0.023) and Cognitive (r=-0.209, P=0.024). When the potentially confounding effect of depression, measured by the Beck Depression Inventory, was controlled for, the regression of seizure severity with QOLIE-31 Seizure Worry remained significant (P=0.006, R(2)=0.153), as did the regression with QOLIE-31 Social Functioning (P=0.002, R(2)=0.184) and the regression with QOLIE-31 Cognitive (P=0.037, R(2)=0.30). These findings indicate that severe and potentially injurious seizure behaviors contribute to anxiety and socially avoidant behavior for persons with intractable epilepsy.     

The duration of temporal lobe epilepsy and seizure outcome after epilepsy surgery

To assess the effect of the duration of epilepsy on the outcome of epilepsy surgery in non-lesional medically refractory temporal lobe epilepsy we reviewed the outcome of 76 patients.MethodsAll patients had anterior temporal resections for “non-lesional” temporal epilepsy (excluding any patient with tumours or vascular malformations but including patients with hippocampal sclerosis). Outcome at one year was assessed using Engel's scale.Results67% had a good outcome (Engel I or II). The mean duration of epilepsy was 23.0 years (range 2.9–46.9 years). Overall, there was no significant difference between patients with good outcome (mean duration 22.4 years) and poor outcome (mean duration 24.2 years) (p = 0.49). The proportion of patients with good outcome was slightly higher in the shorter duration groups. (Duration less than 10 years 75%, 10–19 years 71%, 20–29 years 65%, 30–39 years 62%, and 40–49 years 60% good outcome, p = 0.95).ConclusionWe found no significant associations between outcome and duration of epilepsy.     

The association between periodontal disease and seizure severity in refractory epilepsy patients

PurposePeriodontal diseases are common in most populations and affect people at all socioeconomic levels. Evidence suggests that patients with epilepsy actually have higher risks of dental disease and increased oral health needs, but the frequency and consequences of poor controlled seizures on dental and periodontal health have not been reported before. We aimed to assess the impact of seizure frequency on periodontal status and oral hygiene in a sample of epilepsy patients.MethodsOne hundred and nine consecutive patients treated for epilepsy at the outpatient clinic of our University Hospital were invited to take part in an oral examination to determine their periodontal disease status, together with a control group. In addition, seizure frequency and use of medication were documented.ResultsIn logistic regression model, patients were significantly more susceptible to bad oral hygiene, gingivitis and periodontitis that controls (p < 0.001); seizure frequency was significantly related to bad oral hygiene (p = 0.010), gingivitis (p < 0.001) and periodontitis (p < 0.001). Tooth brushing habits and presence of caries were associated with oral health in patients group.ConclusionOur study found a significant positive correlation between periodontal disease and seizure severity. Epilepsy patients need to focus more on their oral health and quality of oral hygiene.     

Perception of seizure severity and bothersome in refractory focal epilepsy

IntroductionA better understanding of the perception of the severity and bothersome caused by seizure phases (warning, ictal, and postictal phases) can contribute to the orientation strategies for adult people with epilepsy (PWEs).ObjectiveTo assess the seizure severity and bothersome and relate them to the clinical aspects of epilepsy and quality of life (QoL).MethodsThe Seizure Severity Questionnaire (SSQ) was associated with clinical variables and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the QOLIE–31 of 98 PWEs, with a significance level of P < 0.05.ResultsMost patients reported that seizure warnings helped them prepare for the event, with the postictal phase was the most bother symptom. Higher scores on the SSQ were associated with movements in the ictal phase, a prolonged duration, and the presence of mental and physical effects in the postictal phase. No difference was found in the SSQ, according to the seizure type and frequency. There was an association between the NDDI-E > 15 and the SSQ. Higher scores on the SSQ were significantly related to an NDDI-E > 15 (P = 0.013), in the linear regression model. Seizure severity and bothersome compromise the perception of QoL.ConclusionThe SSQ was useful in the assessment of the perception of seizure severity in PWEs. The postictal phase was the most bothersome one. The perception of seizure severity is associated with the presence of depression. Seizure severity correlates inversely with QoL.     

Predictors of seizure outcome in newly diagnosed partial epilepsy: memory performance as a prognostic factor.

The epilepsy patients whose seizures will prove to be refractory should be identified as early as possible, and thus the need for new prognostic factors of intractable epilepsy is evident. The aim of the study was to investigate predictors of seizure outcome in a multivariate analysis. Neurological, electroencephalography (EEG) and neuropsychological variables were analyzed as potential predictors of epilepsy. Eighty-nine newly diagnosed adult patients with partial epilepsy were, after a prospective 2-year follow-up period, categorized into one of the two groups: patients with satisfactorily controlled epilepsy, and patients with refractory epilepsy. Six variables predicted 2-year seizure outcome: presence of spike focus in EEG, partial complex or mixed seizure type, remote symptomatic etiology, moderately impaired memory performance in immediate recall and in delayed recognition of the word list, and age at the time of diagnosis. The correct seizure outcome could be predicted with the model in 94% of newly diagnosed epilepsy patients. The presence of verbal memory impairment at the time of the diagnosis of partial epilepsy is a significant predictor of seizure outcome and, together with clinical and EEG variables, it predicts seizure outcome in the majority of the patients. Memory performance as a prognostic factor is of most value in patients with risk of refractory epilepsy and when used in a multidisciplinary setting.     

The role of functional assessment as an outcome measure in antidementia treatment

Functional assessment refers to the evaluation of performance in basic activities of daily living, instrumental activities of daily living, professional duties, and hobbies. This assessment is particularly relevant in the evaluation of cognitive impairment. In fact, functional decline represents a core feature of dementia according to the DSM-IV criteria. Clinically, functional deterioration represents a diagnostic marker, can be used to chart the course of the disease, and as a prognostic marker as it contributes significantly to caregiver burden and institutionalization. For all these reasons, functional assessment has been widely used as an outcome measure in intervention trials of Alzheimer disease (AD). Appropriate function assessment scales have been developed for use in clinical trials of AD. Studies have shown that functional decline benefits from pharmacological interventions in AD and some other cognitive syndromes. This benefit translates into a stabilization ranging between 6 to 12 months compared to a gradual deterioration in the placebo group. There is rarely reversibility for IADL's lost. There are no functional scales specifically designed for assessment of subjects with non-AD cognitive impairment. Scales specifically developed for Mild Cognitive Impairment and other dementias are needed.     

Favorable seizure outcome in Kabuki make-up syndrome associated with epilepsy

Kabuki make-up syndrome is a mental retardation-malformation syndrome affecting multiple organ systems, with a broad spectrum of neuromuscular dysfunction and mental ability. The incidence of seizures associated with this syndrome ranges from 10 to 40%. However, details of the seizures in this syndrome have not been adequately reported or thoroughly evaluated. In this study, we analyzed seizure characteristics and clinical outcomes in nine patients with Kabuki make-up syndrome. Four patients had generalized seizures and two patients had complex partial seizures, extended to secondary generalized seizures. West's syndrome, complex partial seizure, and atonic seizure were seen in one case each, respectively. Electroencephalograms showed focal spikes in seven cases, diffuse spike and wave burst in one case, and hypsarrhythmia in one case. Seizures were well controlled in eight cases and incompletely controlled in only one case. Together with mental retardation, epilepsy can be a primary feature of Kabuki make-up syndrome. Epilepsy associated with Kabuki make-up syndrome is mainly localization-related epilepsy with a favorable seizure outcome.     

Effects of seizure severity and seizure freedom on the health-related quality of life of an African population of people with epilepsy

PurposeThis 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.MethodsHealth-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 6 months. 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.ResultsThere 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.ConclusionThis 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.     

Social functioning as an outcome measure in schizophrenia studies

Objective: Deficits in social functioning are a core feature of schizophrenia. Method: A literature search of English language articles published between January 1990 and December 2006 was undertaken to identify: i) scales used most frequently to assess social functioning in schizophrenia; and ii) the most frequently used social functioning scales in randomized, controlled trials of antipsychotics. A further search (without time limits) examined their psychometric properties. Results: A total of 301 articles employed social functioning scales in the assessment of schizophrenia. These contained 87 potentially relevant measures. Only 14 randomized, controlled studies of antipsychotic agents were identified that examined social functioning. Scales varied greatly in terms of measurement approach, number and types of domains covered and scoring systems. A striking lack of data on psychometric properties was observed. Conclusion: Limited consensus on the definition and measurement of social functioning exists. The Personal and Social Performance Scale is proposed as a useful tool in future research.     

Source imaging of seizure onset predicts surgical outcome in pediatric epilepsy

ObjectiveTo assess whether ictal electric source imaging (ESI) on low-density scalp EEG can approximate the seizure onset zone (SOZ) location and predict surgical outcome in children with refractory epilepsy undergoing surgery.MethodsWe examined 35 children with refractory epilepsy. We dichotomized surgical outcome into seizure- and non-seizure-free. We identified ictal onsets recorded with scalp and intracranial EEG and localized them using equivalent current dipoles and standardized low-resolution magnetic tomography (sLORETA). We estimated the localization accuracy of scalp EEG as distance of scalp dipoles from intracranial dipoles. We also calculated the distances of scalp dipoles from resection, as well as their resection percentage and compared between seizure-free and non-seizure-free patients. We built receiver operating characteristic curves to test whether resection percentage predicted outcome.ResultsResection distance was lower in seizure-free patients for both dipoles (p = 0.006) and sLORETA (p = 0.04). Resection percentage predicted outcome with a sensitivity of 57.1% (95% CI, 34–78.2%), a specificity of 85.7% (95% CI, 57.2–98.2%) and an accuracy of 68.6% (95% CI, 50.7–83.5%) (p = 0.01).ConclusionIctal ESI performed on low-density scalp EEG can delineate the SOZ and predict outcome.SignificanceSuch an application may increase the number of children who are referred for epilepsy surgery and improve their outcome.     

Duration of ECT-induced tachycardia as a measure of seizure length

The duration of ECT-induced tachycardia in 203 seizures of 28 patients was measured. Tachycardia duration was easily determined; it correlated highly with both motor (cuffed arm) and EEG seizure estimates.     

Preoperative EEG correlates of seizure outcome from epilepsy surgery in children

To identify criteria for selecting pediatric candidates for cortical resection, we compared preoperative standard EEGs, extracranial or intracranial (subdural strip or grid) electrode EEG-video monitoring and imaging studies, and surgical pathology findings with long-term (mean = 6.1 years) seizure outcome. Of 47 children, 83% were either seizure-free or substantially improved. Children with a predominant single interictal focus in standard EEGs over time or with seizures that were mostly well localized (even with equal numbers of bilaterally independent spikes) during monitoring had significantly better outcomes than those who had mostly diffuse or bilaterally independent interictal and ictal discharges. Factors not associated with poor outcomes were some seizures unaccompanied by ictal EEG patterns, spikes in postresection electrocorticograms, extratemporal resection, younger age at surgery, and older age of seizure onset. Significantly more patients with than without tumors were seizure-free. Significantly more preteenagers than teenagers had poorly localized interictal and ictal discharges.     

The development of a QALY measure for epilepsy: NEWQOL-6D

Cost-utility analysis is used to inform the allocation of healthcare resources, using the quality-adjusted life year (QALY) as the outcome measure. We report the development of an epilepsy-specific QALY measure (NEWQOL-6D) derived from the NEWQOL measure of health-related quality of life. Firstly, psychometric and Rasch analyses established the dimension structure of NEWQOL and generated a reduced health state classification system including one item per dimension. Secondly, health states generated by the classification system were valued using Time Trade Off, and the results were modeled to generate a utility score for every health state. A classification system with 6 dimensions (worry about attacks; depression; memory; concentration; stigma; control) was produced, and generalized least squares regression was used to generate utility scores for every health state. This study is the first attempt to derive an epilepsy-specific QALY measure, and the utility values can be used in the economic evaluation of emerging technologies for epilepsy.     

Predictors of seizure outcome after temporal lobectomy for intractable epilepsy

OBJECTIVES: To assess predictors of outcome of temporal lobectomy for intractable epilepsy. MATERIAL AND METHODS: In 63 adult patients operated with anterior temporal lobectomy during 198892, we used logistic regression analysis to assess predictors of being seizure-free (Engel's class I) 2 years after surgery. As potential predictors, we included the following variables: gender, age at operation, age at onset of seizures, epilepsy duration, etiology, generalized vs not generalized seizures, seizure frequency, intelligence quotient, ictal electroencephalography, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), side of resection, and extent of the resection. RESULTS: About 44% of the surgery patients were seizure-free (Engel's class I) 2 years after surgery. In multivariate analysis (n = 55), MRI pathology defined as atrophy in the temporal lobe, angioma, tumor or mesial temporal sclerosis (odds ratio, OR 7.4, 95%CI: 1.7-32.9) and extent of the hippocampal resection (increase of 1 cm) (OR 2.2, 95%CI: 1.1-4.6) predicted being seizure-free. CONCLUSION: Focal pathology in preoperative MRI and the extent of the hippocampal resection were the only significant predictors of being seizure-free after 2 years.     

Wada memory performance predicts seizure outcome after epilepsy surgery in children

PURPOSE: Wada memory asymmetries were examined in children from four comprehensive epilepsy surgery centers who subsequently underwent epilepsy surgery to determine whether Wada memory performance could predict degree of seizure relief in children. METHODS: One hundred fifty-six children (between ages 5 and 16 years) with intractable epilepsy underwent Wada testing before resective epilepsy surgery (93 within the left hemisphere, and 63 within the right hemisphere). Memory stimuli were presented soon after intracarotid amobarbital injection, and recognition memory for the items was assessed after return to neurologic baseline. Eighty-eight children underwent unilateral temporal lobe resection, and 68 had extratemporal lobe resections. One hundred four (67%) children were seizure free (Engel class I), and 52 (33%) were not seizure free (Engel classes II-IV) at follow-up (mean follow-up interval, 2.3 years). RESULTS: Seizure-free children recalled 19.3% more Wada memory items after ipsilateral injection than did non-seizure-free children (p = 0.008). If analysis was restricted to youngsters with temporal lobectomies (TLs), seizure-free children recalled 27.7% more items after ipsilateral injection than did non-seizure-free TL children (p = 0.004). With regard to individual patient prediction, 75% of children who had memory score asymmetries consistent with the seizure focus were seizure free. In contrast, only 56% of children whose memory score asymmetries were inconsistent with the seizure focus were seizure free (p = 0.01). CONCLUSIONS: Results suggest that Wada memory performance asymmetries are related to the degree of seizure relief after epilepsy surgery in children and adolescents.     

The validation of a scale to measure cognitive development in Chinese preschool children

The present study aimed to evaluate the reliability and validity of the cognitive sub-test of the Preschool Developmental Assessment Scale (PDAS) for Hong Kong Chinese children. Participants included 378 children (189 boys and 189 girls) aged 3–6 years old, with 324 children with typical development and 54 children with developmental disabilities. They were administered the cognitive sub-test of the PDAS and the Wechsler Preschool and Primary Scale of Intelligence – Revised (WPPSI-R). The PDAS cognitive sub-test total scores correlated positively with the WPPSI-R scores. It could differentiate children from different age groups, with younger children attaining significantly lower scores than older children. The sub-test could also differentiate children with typical development from those with developmental disabilities, with the latter attaining significantly lower scores. The sensitivity and specificity were around 80%. Internal consistency (KR-20) was .93 and test–retest reliability was .81. The cognitive sub-test of the PDAS was found to be a promising screening tool for the identification of preschool children with developmental disabilities.