Religiosity aspects in patients with epilepsy

The objectives of this study were to assess religiosity aspects in patients with epilepsy (PWEs) and controls and to determine whether such aspects were related to the samples' clinical, sociodemographic, and QOL-31 data. The Duke Religion Index was administered to 159 adult PWEs and 50 controls. The relationships between the Duke Religion Index and the study variables of the two groups were compared. Intrinsic religiosity (IR) and nonorganizational religiosity (NOR) were higher in PWEs than in controls. Logistic regression showed that being female (p = 0.022) and having mesial temporal lobe epilepsy with hippocampus sclerosis (MTLE-HS) (p = 0.003) were predictors of high organizational religiosity (OR) and that high NOR was associated with MTLE-HS (p = 0.026) and controlled seizures. Further, only MTLE-HS (p = 0.002) was predictive of high IR. The Duke Religion Index and QOLIE-31 scores were not related. Different forms of interictal religiosity are related to clinical aspects of epilepsy.     

Fracture risk with use of liver enzyme inducing antiepileptic drugs in people with active epilepsy: Cohort study using the General Practice Research Database

PurposeLiver enzyme inducing antiepileptic drugs (LEI AEDs) have adverse effects on bone metabolism but it is unclear whether this translates into increased fracture risk. This population based cohort study aimed to evaluate whether treatment with LEI AEDs is associated with increased risk of fracture in people with active epilepsy.MethodsThe cohort included patients diagnosed with epilepsy and prescribed AEDs while registered at a GPRD general practice during 1993–2008. The hazard ratio with current use of LEI AEDs for fracture at any site and hip fracture was estimated using Cox proportional hazards models.ResultsThere were 7356 fractures (788 hip fractures) in 63 259 participants. In women, the adjusted hazard ratio with use of LEI AEDs was 1.22 for fracture (95% CI 1.12–1.34; p < 0.001) and 1.49 for hip fracture (1.15–1.94; p = 0.002). In men, the hazard ratio for fracture was 1.09 (0.98–1.20; p = 0.123) and for hip fracture 1.53 (1.10–2.12; p = 0.011). For every 10 000 women treated with LEI AEDs for one year, there could be 48 additional fractures, including 10 additional hip fractures. For every 10 000 men treated with LEI AEDs for one year, there could be 4 additional hip fractures.ConclusionsLEI AEDs may increase the risk of fracture in people with epilepsy. In patients at high risk of osteoporotic fracture alternative AED therapy may be appropriate. Further information is urgently needed on the safety of valproate and newer AEDs and on strategies to maintain bone health in people who need to be treated with LEI.     

Patterns and frequency of the treatment of depression in persons with epilepsy

ObjectiveThough depression is common in persons with epilepsy, it often remains undiagnosed and/or untreated. The current study aimed to determine the proportion of persons with epilepsy receiving depression-related treatment and to characterize the type of treatment received.MethodsPersons with epilepsy (n = 185) from the only epilepsy clinic in a city of 1.2 million people completed questionnaires and the gold-standard Structured Clinical Interview for DSM Disorders (SCID) to assess current and past depression. Treatment for depression (pharmacological and nonpharmacological) was ascertained through patient self-report and chart review.ResultsOf those with current depression (n = 27), the majority (70.3%) were not on any depression-related treatment. In persons with current depression, nonpharmacological management was the most common treatment method, followed by treatment with psychotropic medications such as selective serotonin reuptake inhibitors. More individuals with a past history of depression but without a current episode (n = 43) were treated (37.2%); it was more common for these individuals to be treated with pharmacological measures. After using an algorithm that adjusts the treated prevalence for those who are successfully treated, the adjusted proportion of depression treatment was 53.1%.ConclusionsThe proportion of people treated for current depression in this cohort was very low. Future studies should investigate barriers to treatment and how depression treatment can be optimized for those with epilepsy.     

Validation of the Hospital Anxiety and Depression Scale in patients with epilepsy

ObjectiveDespite the fact that depressive disorders are the most common comorbidities among patients with epilepsy (PWEs), they often go unrecognized and untreated. The availability of validated screening instruments to detect depression in PWEs is limited. The aim of the present study was to validate the Hospital Anxiety and Depression Scale (HADS) in adult PWEs.Methods:A consecutive group of 118 outpatient PWEs was invited to participate in the study. Ninety-six patients met inclusion criteria, completed HADS, and were examined by a trained psychiatrist using Structured Clinical Interview (SCID-I) for DSM-IV-TR. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores for the HADS depression subscale (HADS-D).ResultsReceiver operating characteristic analyses showed areas under the curve at approximately 84%. For diagnoses of MDD, the HADS-D demonstrated the best psychometric properties for a cutoff score ≥ 7 with sensitivity of 90.5%, specificity of 70.7%, positive predictive value of 46.3%, and negative predictive value of 96.4%. In the case of the group with ‘any depressive disorder’, the HADS-D optimum cutoff score was ≥ 6 with sensitivity of 82.5%, specificity of 73.2%, positive predictive value of 68.8%, and negative predictive value of 85.4%.ConclusionsThe HADS-D proved to be a valid and reliable psychometric instrument in terms of screening for depressive disorders in PWEs. In the epilepsy setting, HADS-D maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing MDD with an optimum cutoff score ≥ 7.     

Healthcare utilization and costs in children with stable and uncontrolled epilepsy

ObjectiveEpilepsy adversely affects childhood development, possibly leading to increased economic burden in pediatric populations. We compared annual healthcare utilization and costs between children (< 12 years old) with stable and uncontrolled epilepsy treated with antiepileptic drugs (AEDs).MethodsChildren (< 12 years old) with epilepsy (ICD-9-CM 345.xx or 780.39) in 2008 were identified in the MarketScan claims database from 2007 to 2009. Patients with “stable” epilepsy used the same AED for ≥ 12 months, and patients with “uncontrolled” epilepsy were prescribed additional AED(s) during that period. For patients with uncontrolled epilepsy, the study index date was the start of additional AED(s); for patients with stable epilepsy, the study index date was a random AED fill date. Epilepsy-related utilization included medical services with 345.xx or 780.39 in any diagnosis field and AED fills. Epilepsy-related costs included AEDs, medical claims with epilepsy in any diagnosis field, and certain tests. We adjusted for baseline cohort differences (demographics, region, usual-care physician specialty, and comorbidities) using logistic regression and analysis of covariance.ResultsTwo thousand one hundred seventy patients were identified (mean: 7.5 years; 45.3% were female; Charlson comorbidity index: 0.3; 422 (19.4%) patients with uncontrolled epilepsy). Patients with uncontrolled epilepsy faced more hospitalizations (30.1% vs. 12.0%) and greater overall ($30,343 vs. $18,206) and epilepsy-related costs ($16,894 vs. $7979) (all p < .001). Adjusting for baseline measures, patients with uncontrolled epilepsy had greater odds of hospitalization (OR: 2.5; 95% CI: 1.9–3.3) and costs (overall: $3908, p = .087; epilepsy-related: $5744, p < .001).ConclusionsChildren with uncontrolled epilepsy use significantly more healthcare resources and have a greater economic burden than children with stable epilepsy. However, epilepsy accounted for only half of overall costs, indicating that comorbid conditions may add substantially to the disease burden.     

Gender differences in social support in persons with epilepsy

The present study focused on social support as a key feature of the enhancement and maintenance of mental health. So far, literature on gender differences in social support and its effects on the experience of stress in individuals with epilepsy is scarce. We hypothesized that in individuals with epilepsy, social support buffers detrimental effects of stressors (e.g., unpredictable occurrence of seizures) on mental health. Additionally, we explored the role of gender in this process.In 299 individuals with epilepsy, data from validated questionnaires on seizures in the last 3 months, perceived support, social network size, and depressive symptoms were analyzed.Women reported higher depressive symptoms (t = 2.51, p < .01) and higher perceived support (t = 2.50, p < .01) than men. Women and men did not differ in social network size (t = − 0.46, p = 64), nor in experiencing seizures (χ² = 0.07, p = .82). Regression analyses revealed no buffer effects. Perceived support was negatively associated with depressive symptoms (B = − 0.49, p < .001, 95% CI [− 0.67; − 0.32]). With regard to depressive symptoms, social integration was slightly more beneficial for women (B_cond. = − 0.06, p < .001; 95% CI [− 0.09; − 0.03]) than for men (B_cond. = − 0.02, p = .09; 95% CI [− 0.04; 0.01]).Findings present perceived support and social integration as general health resources in individuals with epilepsy regardless of previously experienced seizures. They also encourage further research on gender-specific effects in individuals with epilepsy and move towards recommendations for practitioners and gender-specific interventions. Future aims will be to enhance social integration in order to support adjustment to the chronic condition of epilepsy and to improve individuals' confidence in support interactions.     

Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy

ObjectiveWe examined patterns of antiepileptic drug (AED) use in a cohort of Iraq/Afghanistan war veterans (IAVs) who were previously identified as having epilepsy. We hypothesized that clinicians would be more likely to prescribe newer AEDs and would select specific AEDs to treat seizures based on patient characteristics including gender and comorbidities.MethodsFrom the cohort of IAVs previously identified with epilepsy between fiscal years 2009 and 2010, we selected those who received AEDs from the Veterans Health Administration in FY2010. Regimens were classified as monotherapy or polytherapy, and specific AED use was examine overall and by gender. Multivariable logistic regression examined associations of age; gender; race/ethnicity; medical, psychiatric, and neurological comorbidities; and receipt of neurology specialty care associated with the six most commonly used AEDs.ResultsAmong 256,284 IAVs, 2123 met inclusion criteria (mean age: 33 years; 89% men). Seventy-two percent (n = 1526) received monotherapy, most commonly valproate (N = 425) and levetiracetam (n = 347). Sixty-one percent of those on monotherapy received a newer AED (levetiracetam, topiramate, lamotrigine, zonisamide, oxcarbazepine). Although fewer women than men received valproate, nearly 90% (N = 45) were of reproductive age (≤ 45 years). Antiepileptic drug prescribing patterns were associated with posttraumatic stress disorder, bipolar disorder, cerebrovascular disease, dementia/cognitive impairment, headache, and receipt of neurological specialty care (all p < 0.01).SignificanceIn this cohort of veterans with epilepsy, most received AED monotherapy and newer AEDs. Prescribing patterns were different for men and women. The patterns observed between AEDs and neurological/psychiatric comorbidities suggest that clinicians are practicing rational prescribing.     

Medication prescribing and patient-reported outcome measures in people with epilepsy in Bhutan

ObjectiveThe aim of this study was to assess medication prescribing and patient-reported outcomes among people with epilepsy (PWE) in Bhutan and introduce criteria for evaluating unmet epilepsy care needs, particularly in resource-limited settings.MethodsPeople with epilepsy in Bhutan (National Referral Hospital, 2014–2015) completed a questionnaire, the Quality of Life in Epilepsy Inventory (QOLIE-31), and an electroencephalogram (EEG). Management gap was the proportion of participants meeting any of six prespecified criteria based on best practices and the National Institute for Health and Care Excellence (NICE) guidelines.ResultsAmong 253 participants (53% female, median: 24 years), 93% (n = 235) were treated with antiepileptic drugs (AEDs). Seventy-two percent (n = 183) had active epilepsy (≥ 1 seizure in the prior year). At least one criterion was met by 55% (n = 138) of participants, whereas the treatment gap encompassed only 5% (n = 13). The criteria were the following: 1. Among 18 participants taking no AED, 72% (n = 13) had active epilepsy. 2. Among 26 adults on subtherapeutic monotherapy, 46% (n = 12) had active epilepsy. 3. Among 48 participants reporting staring spells, 56% (n = 27) were treated with carbamazepine or phenytoin. 4. Among 101 female participants aged 14–40 years, 23% (n = 23) were treated with sodium valproate. 5. Among 67 participants reporting seizure-related injuries, 87% (n = 58) had active epilepsy. 6. Among 111 participants with a QOLIE-31 score below 50/100, 77% (n = 86) had active epilepsy. Years since first AED treatment (odds ratio: 1.07, 95% CI: 1.03, 1.12) and epileptiform discharges on EEG (odds ratio: 1.95, 95% CI: 1.15, 3.29) were significantly associated with more criteria met.ConclusionsBy defining the management gap, subpopulations at greatest need for targeted interventions may be prioritized, including those already taking AEDs.     

How predictable is the erectile function of patients with epilepsy?

IntroductionErectile dysfunction (ED) is often reported by patients with epilepsy and may be related to endocrine system abnormalities, side effects of antiepileptic drugs, psychiatric comorbidities, and family or social difficulties.AimsThis study aimed to identify independent predictor factors for ED in patients with epilepsy.Main outcome measuresthe five-question form of the International Index of Erectile Function (IIEF-5).MethodsIndependent predictive factors for ED evaluated by the IIEF-5 questionnaire in 36 patients (mean age: 39 years) with focal epilepsy (mean: 6 seizures/month) were identified by multiple linear regression analysis.ResultsEight (21.1%) patients were asymptomatic. Among the symptomatic patients, 11 (28.9%) had mild dysfunction, 10 (26.3%) had moderate dysfunction, and 9 (23.7%) showed severe ED. The multiple linear regression model including family income (B = 0.005; p = 0.05), education levels in years (B = 0.54; p = 0.03), depressive symptoms determined by HADS depression subscale (B = − 0.49; p = 0.03), and prolactin levels (B = − 0.45; p = 0.07) showed a moderate association (r = 0.64) with the IIEF questionnaire and explained 41% (r² = 0.41) of its variation.ConclusionsErectile dysfunction is highly prevalent in patients with focal epilepsies. Education, depressive symptoms, and prolactin levels can predict erectile dysfunction in up to 41% of patients with epilepsy. This preliminary report justifies further efforts to make a large sample size study to identify independent biomarkers and therapeutic targets for ED treatment in patients with epilepsy.     

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.     

Psychosocial and sociodemographic associates of felt stigma in epilepsy

BackgroundLack of a sufficient range in socioeconomic status (SES) in most prior studies of felt stigma and epilepsy has hampered the ability to better understand this association.MethodsWe assessed the burden and associates of felt stigma in 238 individuals with prevalent epilepsy aged 18 and older, comparing low SES with high SES.ResultsReported levels of stigma were higher in low SES than in high SES (p < 0.0001), and all psychosocial variables were associated with stigma, including depression severity (p < 0.0001), knowledge of epilepsy (p = 0.006), quality of life (p < 0.0001), social support (p < 0.0001), and self-efficacy (p = 0.0009). Stigma was statistically significantly associated with quality of life in the low SES group and with depression severity and social support in the high SES group.ConclusionsLow SES alone did not account for felt stigma; rather, we found that quality of life, depressive symptoms, and social support have the greatest impact on reported felt stigma in individuals with prevalent epilepsy.     

Self-concept and gender effects in Korean adolescents with epilepsy

PurposeWe aimed to determine whether adolescents with epilepsy (AWE) have a compromised self-concept, whether a lower self-concept is related to mental health, and whether there are sex differences in self-concept in AWE.MethodsA total of 179 AWE and 259 control adolescents without epilepsy participated in this cross-sectional, multicenter study. Self-concept was measured using the Harter's Self-Perception Profile for Children. Depressive symptoms and anxiety were assessed by the Hospital Anxiety Depression Scale (HADS). A group-by-sex interaction was evaluated using an analysis of covariance controlling for age.ResultsAdolescents with epilepsy had a lower level of self-concept, especially in domains of behavioral conduct (partial eta²: 0.257) and social acceptance (partial eta²: 0.116), than controls (p < 0.05). The level of self-concept did not differ by sex in the group with epilepsy. A group-by-sex interaction effect was found on social acceptance (p = 0.042). Unlike the control group, age was not correlated with self-concept in AWE. Physical appearance was negatively correlated with HADS-anxiety scores (r = − 0.291, p < 0.01) but only in girls with epilepsy. Epilepsy duration was correlated with social acceptance in boys (r = 0.211, p < 0.05) and physical appearance in girls (r = − 0.249, p < 0.05).ConclusionsAdolescents with epilepsy had a lower level of self-concept, especially in the domains of behavioral conduct and social acceptance, than controls. Sex differences in self-concept were identified in the control group but not in the group with epilepsy. Physical appearance was negatively correlated with anxiety in girls with epilepsy.     

Utilization of care among drug resistant epilepsy patients with symptoms of anxiety and depression

PurposeEpilepsy patients have a significantly higher rate of anxiety and depression than the general population, and psychiatric disease is particularly prevalent among drug resistant epilepsy patients. Symptoms of anxiety and depression might serve as a barrier to appropriate epilepsy care.The aim of this study was to determine if drug resistant epilepsy patients with symptoms of anxiety and/or depression receive different epilepsy management than controls.MethodWe identified 83 patients with drug resistant focal epilepsy seen at the Penn Epilepsy Center. Upon enrollment, all patients completed 3 self-report scales and a neuropsychiatric inventory and were grouped into those with symptoms of anxiety and/or depression and controls. Each patient's medical records were retrospectively reviewed for 1–2 years, and objective measures of outpatient and inpatient epilepsy management were assessed.ResultsAt baseline, 53% (n = 43) of patients screened positive for symptoms of anxiety and/or depression. The remaining 47% (n = 38) served as controls. Patients with anxiety and/or depression symptoms had more missed outpatient visits per year compared to controls (median 0.84 vs. 0.48, p = 0.02). Patients with symptoms of both anxiety and depression were more likely to undergo an inpatient admission or procedure (56% vs. 24%, p = 0.02).ConclusionFor most measures of epilepsy management, symptoms of anxiety and/or depression do not alter epilepsy care; however, drug resistant epilepsy patients with anxiety and/or depression symptoms may be more likely to miss outpatient appointments, and those with the highest burden of psychiatric symptoms may be admitted more frequently for inpatient services compared to controls.     

Disclosure management behaviors in Korean adults with well-controlled epilepsy: Their relation to perception of stigma

PurposeIn spite of the fact that epilepsy is a concealable stigmatized identity, there is little evidence pertaining to disclosure management in adults living with epilepsy. We determined the factors contributing to disclosure management strategies in adults living with well-controlled epilepsy.MethodsThis was a cross-sectional multicenter study. Korean adults whose seizures had remitted for at least one year participated in this study. Using statistical analyses, we determined whether disclosure management behaviors measured using the Disclosure Management Scale (DMS) were related to demographic, clinical, and psychosocial variables. The Stigma Scale and Hospital Anxiety Depression Scale (HADS) were used.ResultsOf a total of 225 participants, 76% stated that they often or sometimes kept their epilepsy a secret, while 24% reported that they never or rarely kept their diagnosis hidden. The mean DMS score was 6.1 (SD = 2.4). In univariate analyses, the DMS scores were significantly related to the HADS depression scores (r = 0.187, p = 0.005) and the presence of perceived stigma (p = 0.001). In linear regression analyses, perceived stigma was identified only as an independent factor associated with DMS scores (p = 0.031), while HADS depression lost significance (p = 0.057). The presence of perceived stigma explained only 4.6% of the variance in DMS scores.ConclusionsOur study shows that over 70% of Korean adults with well-controlled epilepsy often or sometimes keep their epilepsy a secret. Although perceived stigma is associated with concealment behaviors, it accounts for only a small proportion of the variance in disclosure management.     

The influence of patient,caregiver, and family factors on symptoms of anxiety and depression in children and adolescents with intractable epilepsy

ObjectiveThe objective was to evaluate the association of caregiver and family factors with symptoms of anxiety and depression in children and adolescents with medically refractory localization-related epilepsy (i.e., failed at least two epilepsy medications).MethodForty-four children (ages 6–11 years) and 65 adolescents (ages 12–18 years) and their parents participated in this multicentered, observational, cross-sectional study. Univariable and multivariable linear regressions were used to evaluate the influence of multiple patient, caregiver, and family characteristics on self-reported symptoms of anxiety and depression in the children and adolescents.ResultsAmong children, depressive symptoms were associated with a lower proportion of life with seizures (β = .344, p = .022), caregiver depression (β = .462, p = .002), poorer family relationships (β = .384, p = .010), and poorer family mastery and social support (β = .337, p = .025); in multivariable analysis, proportion of life with epilepsy and parental depression remained significant. No significant predictors of anxiety were found among children. Among adolescents, depressive symptoms were associated with caregiver unemployment (β = .345, p = .005) and anxiety (β = .359, p = .003), low household income (β = .321, p = .012), poorer family mastery and social support (β = .334, p = .007), and greater family demands (β = .326, p = .008); in multivariable analysis, caregiver unemployment and anxiety remained significant. Greater anxiety symptoms among adolescents were associated with females (β = .320, p = .009) and caregiver depression (β = .246, p = .048) and anxiety (β = .392, p = .001) and poorer family mastery and social support (β = .247, p = .047); in multivariable analysis, female sex and caregiver anxiety remained significant.SignificanceThese findings highlight the central role of caregiver psychopathology, which is amenable to intervention, on children and adolescents' symptoms of anxiety and depression. Addressing caregiver psychopathology may improve children and adolescents' quality of life even if seizure control is not attained.     

Prognosis of status epilepticus (SE): Relationship between SE duration and subsequent development of epilepsy

In animal models, SE duration is related to epileptogenesis. Data in humans are scarce, mainly in NCSE; therefore, we aimed to study the prognosis of SE de novo and which factors may influence subsequent development of epilepsy.MethodsWe evaluated patients with SE without previous epilepsy at our hospital (February 2011–February 2014), including demographics, etiology, number of AEDs, duration of SE, mortality, and occurrence of seizures during follow-up.ResultsEighty-nine patients were evaluated. Median age was 69 (19–95) years old. Among them, 33.7% were convulsive. Regarding etiology, 59 were considered acute symptomatic (41 lesions, 18 toxic–metabolic), 17 remote or progressive symptomatic, and 13 cryptogenic. The median recovery time was 24 h (30 min–360 h). In-hospital mortality was 29% (n = 26). After a median follow-up of 10 months, 58.7% of survivors (n = 37) showed seizures. Subsequently, we analyzed which factors might be related to the development of epilepsy, and we found that epilepsy development was more frequent with longer SE duration (37 vs. 23 h, p = 0.004); furthermore, patients with a toxic–metabolic etiology developed epilepsy less frequently (33% vs. 67%; p = 0.022). Epilepsy was also correlated (tendency) with focal SE (p = 0.073), a lesion in neuroimaging (p = 0.091), and the use of 2 or more AEDs (p = 0.098). Regarding SE duration, a cutoff of above 24 h was clearly related to chronic seizures (p = 0.014); however, combining etiology and duration, the association of longer SE and epilepsy was significant in acute lesional SE (p = 0.034), but not in epilepsy with cryptogenic or remote/progressive etiology. After a logistic regression, only a duration longer than 24 h (OR = 3.800 (1.277–11.312), p = 0.016) was found to be an independent predictor of the development of epilepsy.ConclusionIn patients with SE, the longer duration is associated with an increased risk of subsequent epilepsy at follow-up, mainly in symptomatic SE due to an acute lesion. It is unclear if it might be the result of a more severe injury causing both prolonged seizures and subsequent epilepsy, and therefore whether more aggressive treatment in this group might avoid this possibility. Most of the patients with cryptogenic or remote/progressive SE developed epilepsy regardless of SE duration.This article is part of a Special Issue entitled “Status Epilepticus”.     

Counseling and social work for persons with epilepsy: Observational study on demand and issues in Hessen,Germany

The goal of the social management of epilepsy is to decrease the physical, psychological, and social consequences for persons with epilepsy (PWEs). The objective of this observational study was to determine the needs and issues of PWEs in the utilization of epilepsy counseling services between 2008 and 2012 in the German state of Hessen.Sociodemographic data, employment status, counseling issues, and characteristics were collected at first and follow-up visits. An average of 492 (272 males, 55.3%) PWEs presented at counseling services per year. These were mainly children or adolescents below the age of 20 years (22.4%) and PWEs in working age between 20 and 65 years (73.6%). The majority of PWEs seeking counseling were employed (44.4%, annual average: 219 PWEs, SD: 39). However, a substantial part (114/219, 52.1%) of these employed PWEs reported problems or difficulties at their workplace associated with the diagnosis of epilepsy. We could identify four major issues addressed by the PWEs as 1) diagnosis of epilepsy, 2) employment, 3) family-related matters, and 4) social or medical aids linked with public authorities.This study demonstrated the continuous demand for epilepsy counseling with at least one out of twenty (5.8%) PWEs in need of counseling per year. Further studies are warranted to answer questions on outcome and long-term course. Epilepsy counseling should be available to all PWEs on a national level and may be helpful in preventing long-term unemployment and early retirement while maintaining quality of care for PWEs.     

Predictors of quality of life and their interrelations in Korean people with epilepsy: A MEPSY study

PurposePeople with epilepsy (PWE) are more likely to have impaired quality of life (QOL) than the general population. We studied predictors of QOL and their interrelations in Korean PWE.MethodsSubjects who consecutively visited outpatient clinics in four tertiary hospitals and one secondary care hospital were enrolled. These subjects completed the Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), the Generalized Anxiety Disorder-7 (GAD-7), the Quality of Life in Epilepsy-10 (QOLIE-10), and the Korean version of Liverpool Adverse Event Profile (K-LAEP). We evaluated the predictors of QOL by multiple regression analyses and verified the interrelations between the variables using a structural equation model.ResultsA total of 702 PWE were eligible for the study. The strongest predictor of the overall QOLIE-10 score was the K-LAEP score (β = −0.375, p < 0.001), followed by the K-NDDI-E score (β = −0.316, p < 0.001), seizure control (β = −0.152, p < 0.001), household income (β = −0.375, p < 0.001), and GAD-7 score (β = −0.119, p = 0.005). These variables explained 68.7% of the variance in the overall QOLIE-31 score. Depression and seizure control had a bidirectional relationship and exerted direct effects on QOL. These factors also exerted indirect effects on QOL by provoking adverse effects of AEDs. Anxiety did not have a direct effect on QOL; it had only indirect effect through the adverse effects of AEDs.ConclusionDepression, anxiety, seizure control, and adverse effects of AEDs have complex interrelations that determine the QOL of PWE.     

Different attachment styles correlate with mood disorders in adults with epilepsy or migraine

PurposeInterpersonal relationships are viewed as important contexts within which psychopathology emerges and persists or desists. Attachment theory describes the dynamics of long-term relationships between humans especially in families and lifelong friendships. The present study was aimed at investigating attachment styles in adult patients with epilepsy as compared to subjects with migraine and their potential correlates with a history of mood disorders.MethodsA consecutive sample of 219 adult outpatients with epilepsy (117) or migraine (102) was assessed with the Attachment Style Questionnaire (ASQ).ResultsPatients with epilepsy and a lifetime history of mood disorders presented elevated scores for Need for approval (p < 0.001) and Preoccupation with relationships (p < 0.001). Age correlated with the Relationships as secondary (r = 0.322; p < 0.001) and Need for approval (r = 0.217; p = 0.019) subscales while age at onset correlated only with Relationships as secondary (r = 0.225; p = 0.015). Seizure-free patients presented lower scores for Need for approval (p = 0.003). Patients with migraine and a lifetime history of mood disorders presented lower scores in Confidence (p = 0.002) and higher scores in Discomfort with closeness (p = 0.026).ConclusionsAn anxious–preoccupied attachment correlated with mood disorders in epilepsy while it was an avoidant pattern in migraine. Our results bring further data on the role of psychological variables in mood disorders in epilepsy. Further studies will allow early identification of patients at risk and the development of preventive strategies.     

Identifying depression in epilepsy in a busy clinical setting is enhanced with systematic screening

PurposeDepression is a highly prevalent, relatively underdiagnosed and undertreated comorbid condition in epilepsy. The purpose of this study was to determine the effect of using a validated self-reporting depression scale on the ability to detect depression in people with epilepsy receiving care in a busy clinical setting.MethodsThe Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is a 6-item questionnaire validated to screen for depression in people with epilepsy. We performed a retrospective chart review of 192 consecutive patients who had completed the NDDI-E while receiving care at a seizure clinic in the largest public hospital in Houston, Texas. For comparison, charts of 192 consecutive patients receiving care immediately prior to the implementation of the NDDI-E in the same clinic were assessed.ResultsFifty-five (28.6%) of patients screened positive for depression with the NDDI-E. They subsequently received a semi-structured psychiatric interview based on the DSM-IV model and 89% (n = 49) were confirmed to have major depression. Use of the NDDI-E thus resulted in the detection of active depression in 25.5% (n = 49) of the patients, whereas only 2.6% (n = 5) of patients in the group not systematically screened were found to have active depression (p < 0.0001). Thirty-two of the 49 (65%) patients with depression detected by screening were not previously diagnosed or treated. Multivariate analysis revealed that a history of depression, seizure frequency, and topiramate use were independent predictors of depression. Lamotrigine use was protective against depression.DiscussionUse of the NDDI-E significantly improved the ability to detect depression in epilepsy patients in a busy clinical practice.