Improving the mental health of adolescents with epilepsy through a group cognitive behavioral therapy program

The threat of unpredictable seizures makes epilepsy unique among childhood chronic illnesses. One consequence is that people who have childhood-onset epilepsy often have poor social adjustment and competence in adulthood. Better emotional and social functioning could improve long-term outcomes. Thirty-four adolescents with epilepsy participated in a group cognitive behavioral therapy program designed to enhance their level of psychosocial functioning. Baseline Strength and Difficulty Questionnaire scores suggested that many participants had difficulties with emotions, concentration, and social functioning, with parent-reported Impact scores significantly worse than adolescent-reported scores (p = 0.005). Four months after the intervention, adolescent-reported Prosocial Behavior scores significantly improved (p = 0.03). Parent-reported scores improved significantly at follow-up, compared with baseline, in Peer Problems (p = 0.04), Impact (p = 0.001), and Prosocial Behavior (p = 0.004) scores. Adolescents with lower socioeconomic status reported the greatest improvements (p = 0.01). A brief CBT intervention was effective and resulted in improved mental health indices and social functioning for adolescents with epilepsy.     

Comparing the effects of cortical resection and vagus nerve stimulation in patients with nonlesional extratemporal epilepsy

The main purpose of this retrospective study was to compare the effects of resective surgery (RESgr—26 patients) and vagus nerve stimulation (VNSgr—35 patients) on seizure frequency (2 and 5 years after surgery) in patients with nonlesional extratemporal epilepsy (NLexTLE). We analyzed hospital admission costs directly associated with epilepsy (HACE) in both groups at the same follow-up. The decrease in seizure frequency from the preoperative levels, in both VNSgr and RESgr, was statistically significant (p < 0.001). The seizure frequency reduction did not differ significantly between the follow-up visits for either group (p = 0.221 at 2 years and 0.218 at 5 years). A significantly higher number of Engel I and Engel I + II patients were found in RESgr than in VNSgr at both follow-up visits (p = 0.04 and 0.007, respectively). Using McHugh classification, we did not find statistically significant differences between both groups at both follow-up visits. Hospital admission costs directly associated with epilepsy/patient/year in both RESgr and VNSgr dropped significantly at 2- and 5-year follow-up visit and this reduction was not statistically different between RESgr and VNSgr (p = 0.232).Both VNS and resective surgery cause comparably significant seizure reduction in NLexTLE. Resective surgery leads to a greater number of patients with excellent postoperative outcome (Engel I + II). The HACE reduction is statistically comparable between both groups.     

Patient satisfaction with temporal lobectomy/selective amygdalohippocampectomy for temporal lobe epilepsy and its relationship with Engel classification and the side of lobectomy

PurposeThe aim of this study was to investigate not only the effectiveness of epilepsy surgery in improving seizure control but also patient satisfaction with the result of the procedure in a sample of patients operated on at a specialized epilepsy unit.MethodsPatients with temporal lobe epilepsy who had undergone epilepsy surgery (temporal lobectomy/amygdalohippocampectomy) were interviewed in a standardized telephone survey about their satisfaction with the results of the surgery. The morbidity of the surgery was also analyzed retrospectively. The initial study population consisted of 6 amygdalohippocampectomy and 102 temporal lobectomy patients and was reduced to a final sample consisting of 4 amygdalohippocampectomy and 67 lobectomy patients, as the other patients were not available for interview. Surgical results were based on the Engel classification, and satisfaction with the surgery was assessed by asking patients to rate their result and state whether they would make the same decision (to be operated on) again.ResultsA significant number of patients classified as Engel I or II, who considered the surgical outcome good or excellent, said they would have the surgery again (p < 0.001). Left temporal lobectomy patients whose results fell in the Engel III/IV bracket were less satisfied (p = 0.001) than right temporal lobectomy patients with the same Engel classifications (0.048). Left temporal lobectomy patients who were classified as Engel class III and IV were less likely to have the surgery again if they had the choice (p = 0.016).DiscussionPatient satisfaction with the results of epilepsy surgery may depend not only on achieving seizure control but also on the temporal lobe resected. Since worse results were associated with lower satisfaction rates only for left temporal resection patients, it is possible that the cognitive consequences of this procedure compound the worse surgical result, leading to decreased satisfaction.     

Association of social support and quality of life among people with schizophrenia receiving community psychiatric service: A cross-sectional study

ObjectiveTo understand the needs of patients with schizophrenia for recovery, this study examined the type and level of social support and its association with quality of life (QOL) among this group of patients in the city of Kuala Lumpur.MethodA cross-sectional study was conducted on 160 individuals with schizophrenia receiving community psychiatric services in Hospital Kuala Lumpur (HKL). The WHOQOL-BREF, Brief Psychiatric Rating Scale (BPRS) and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess QOL, severity of symptoms and social support, respectively. The study respondents were predominantly Malay, aged less than 40, males, single, unmarried, had lower education levels and unemployed.ResultsAbout 72% of the respondents had poor perceived social support, with support from significant others being the lowest, followed by friends and family. From multiple regression analysis, social support (total, friend and family) significantly predicted better QOL in all domains; [B = 0.315 (p < 0.001), B = 0.670 (p < 0.001), B = 0.257 (p < 0.031)] respectively in Physical Domain; [B = 0.491 (p < 0.001), B = 0.735 (p < 0.001), B = 0.631 (p < 0.001)] in Psychological Domain; [B = 1.065 (p < 0.001), B = 0.670 (p < 0.017), B = 2.076 (p < 0.001)] in Social Domain and; [B = 0.652 (p < 0.001), B = 1.199 (p < 0.001), B = 0.678 (p < 0.001)] in Environmental Domain. Being married and having shorter duration of illness, lower BPRS (total) scores, female gender and smoking, were also found to significantly predict higher QOL.ConclusionSocial support is an important missing component among people with schizophrenia who are already receiving formal psychiatric services in Malaysia.     

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.     

Long-term seizure and psychosocial outcomes after resective surgery for intractable epilepsy

Resective surgery is considered an effective treatment for refractory localization-related epilepsy. Most studies have reported seizure and psychosocial outcomes of 2–5 years postsurgery and a few up to 10 years. Our study aimed to assess long-term (up to 15 years) postsurgical seizure and psychosocial outcomes at our epilepsy center. The Henry Ford Health System Corporate Data Store was accessed to identify patients who had undergone surgical resection for localization-related epilepsy from 1993 to 2011. Demographics including age at epilepsy onset and surgery, seizure frequency before surgery, and pathology were gathered from electronic medical records. Phone surveys were conducted from May 2012 to January 2013 to determine patients' current seizure frequency and psychosocial metrics including driving and employment status and use of antidepressants. Surgical outcomes were based on Engel's classification (classes I and II = favorable outcomes). McNemar's tests, chi-square tests, two sample t-tests, and Wilcoxon two sample tests were used to analyze the relationships of psychosocial and surgical outcomes with demographic and surgical characteristics. A total of 470 patients had resective epilepsy surgery, and of those, 50 (11%) had died since surgery. Of the remaining, 253 (60%) were contacted with mean follow-up of 10.6 ± 5.0 years (27% of patients had follow-up of 15 years or longer). Of the patients surveyed, 32% were seizure-free and 75% had a favorable outcome (classes I and II). Favorable outcomes had significant associations with temporal resection (78% temporal vs 58% extratemporal, p = 0.01) and when surgery was performed after scalp EEG only (85% vs 65%, p < 0.001). Most importantly, favorable and seizure-free outcome rates remained stable after surgery over long-term follow-up [i.e., < 5 years (77%, 41%), 5–10 years (67%, 29%), 10–15 years (78%, 38%), and > 15 years (78%, 26%)]. Compared to before surgery, patients at the time of the survey were more likely to be driving (51% vs 35%, p < 0.001) and using antidepressants (30% vs 22%, p = 0.013) but less likely to be working full-time (23% vs 42%, p < 0.001). A large majority of patients (92%) considered epilepsy surgery worthwhile regardless of the resection site, and this was associated with favorable outcomes (favorable = 98% vs unfavorable = 74%, p < 0.001). The findings suggest that resective epilepsy surgery yields favorable long-term postoperative seizure and psychosocial outcomes.     

Major depressive disorder as a predictor of a worse seizure outcome one year after surgery in patients with temporal lobe epilepsy and mesial temporal sclerosis

PurposeThe association between pre-surgical psychiatric disorders (PDs) and worse seizure outcome in patients with refractory epilepsy submitted to surgery has been increasingly recognized in the literature. The present study aimed to verify the impact of pre- and post-surgical PD on seizure outcome in a series of patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE–MTS).MethodData from 115 TLE–MTS patients (65 females; 56.5%) who underwent cortico-amygdalohippocampectomy (CAH) were analyzed. Pre- and post-surgical psychiatric evaluations were performed using DSM-IV and ILAE criteria. The outcome subcategory Engel IA was considered as corresponding to a favorable prognosis. A multivariate logistic regression model was applied to identify possible risk factors associated with a worse seizure outcome.ResultsPre-surgical PDs, particularly major depressive disorder (MDD), anxiety and psychotic disorders, were common, being found in 47 patients (40.8%). Fifty-six patients (48.7%) were classified as having achieved an Engel IA one year after CAH. According to the logistic regression model, the presence of pre-surgical MDD (OR = 5.23; p = 0.003) appeared as the most important risk factor associated with a non-favorable seizure outcome.ConclusionAlthough epilepsy surgery may be the best treatment option for patients with refractory TLE–MTS, our findings emphasize the importance of performing a detailed psychiatric examination as part of the pre-surgical evaluation protocol.     

Long-term outcome and predictors of resective surgery prognosis in patients with refractory extratemporal epilepsy

PurposeWe analyzed the long-term postoperative outcome and possible predictive factors of the outcome in surgically treated patients with refractory extratemporal epilepsy.MethodsWe retrospectively analyzed 73 patients who had undergone resective surgery at the Epilepsy Center Brno between 1995 and 2010 and who had reached at least 1 year outcome after the surgery. The average age at surgery was 28.3 ± 11.4 years. Magnetic resonance imaging (MRI) did not reveal any lesion in 24 patients (32.9%). Surgical outcome was assessed annually using Engel's modified classification until 5 years after surgery and at the latest follow-up visit.ResultsFollowing the surgery, Engel Class I outcome was found in 52.1% of patients after 1 year, in 55.0% after 5 years, and in 50.7% at the last follow-up visit (average 6.15 ± 3.84 years). Of the patients who reached the 5-year follow-up visit (average of the last follow-up 9.23 years), 37.5% were classified as Engel IA at each follow-up visit. Tumorous etiology and lesions seen in preoperative MRI were associated with significantly better outcome (p = 0.035; p < 0.01). Postoperatively, 9.6% patients had permanent neurological deficits.ConclusionSurgical treatment of refractory extratemporal epilepsy is an effective procedure. The presence of a visible MRI-detected lesion and tumorous etiology is associated with significantly better outcome than the absence of MRI-detected lesion or other etiology.     

Comparison of the clinical profile of Parkinson's disease between Spanish and Cameroonian Cohorts

BackgroundThere are limited data in terms of the clinical profile of Parkinson's disease in sub-Saharan African patients.ObjectiveTo compare the clinical profile and access to standard antiparkinsonian therapies of a Cameroonian cohort of patients with an age, sex, and disease duration-matched Spanish cohort (Longitudinal Study of Parkinson's disease, ELEP).MethodsObservational, cross-sectional design. Demographic data were collected and the following ELEP assessments were applied: Scales for Outcomes in Parkinson's disease (SCOPA) Motor, Autonomic, Cognition, Sleep and Psychosocial; Hoehn and Yahr staging; modified Parkinson Psychosis Rating Scale; Cumulative Illness Rating Scale-Geriatrics; Hospital Anxiety and Depression Scale; pain and fatigue visual analog scales; Zarit, and EuroQoL.Results74 patients with idiopathic Parkinson's disease were included (37 from each country) with a mean age of 64.4 ± 10.5 years old, 70.3% males, and mean disease duration of 5.6 ± 5.9 years. Compared to the Spanish cohort, Cameroonians were intermittently treated, less frequently received dopaminergic agonists (p < 0.001), had a trend for taking lower doses of levodopa (p = 0.06), and were more frequently on anticholinergics (p < 0.0005). Cameroonians were more severely impaired in terms of motor (Hoehn Yahr stage, p = 0.03; SCOPA-Motor, p < 0.001), cognitive status (p < 0.001), anxiety and depression (p < 0.001), psychosis (p = 0.008), somnolence, fatigue and pain (p < 0.001, respectively), caregiver burden (p < 0.0001), and quality of life (p = 0.002). Instead, autonomic, comorbidity, and nocturnal sleep problems were similarly found.ConclusionsLimited and intermittent access to dopaminergic drugs has a negative impact on motor symptoms, nonmotor symptoms and quality of life in patients with Parkinson's disease and their caregivers.     

The relationship of depression to antiepileptic drug adherence and quality of life in epilepsy

We sought to examine the impact of depression upon antiepileptic drug (AED) adherence in patients with epilepsy. We administered the Center for Epidemiologic Studies Depression Scale (CES-D), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Seizure Severity Questionnaire (SSQ), and Quality of Life in Epilepsy-10 (QOLIE-10) and measured AED adherence by utilizing the medication possession ratio (MPR) in adult patients with epilepsy identified through a pharmacy claims database. From a sampling frame of over 10,000 patients identified in claims, 2750 were randomly selected and contacted directly by mail to participate in the cross-sectional survey. A total of 465 eligible patients completed a survey. Survey data were combined with administrative claims data for analysis. We conducted a path analysis to assess the relationships between depression, adherence, seizure severity, and quality of life (QOL). Patients with depression scored significantly worse on measures of seizure severity (p = .003), QOL (p < .001), and adherence (p = .001). On path analysis, depression and QOL and seizure severity and QOL were related, but only the NDDI-E scores had a significant relationship with medication adherence (p = .001). Depression as measured by the NDDI-E was correlated with an increased risk of AED nonadherence. Depression or seizure severity adversely impacted QOL. These results demonstrate yet another important reason to screen for depression in epilepsy.     

Quality-of-life metrics with vagus nerve stimulation for epilepsy from provider survey data

ObjectiveDrug-resistant epilepsy is a devastating disorder associated with diminished quality of life (QOL). Surgical resection leads to seizure freedom and improved QOL in many epilepsy patients, but not all individuals are candidates for resection. In these cases, neuromodulation-based therapies such as vagus nerve stimulation (VNS) are often used, but most VNS studies focus exclusively on reduction of seizure frequency. QOL changes and predictors with VNS remain poorly understood.MethodUsing the VNS Therapy Patient Outcome Registry, we examined 7 metrics related to QOL after VNS for epilepsy in over 5000 patients (including over 3000 with ≥ 12 months follow-up), as subjectively assessed by treating physicians. Trends and predictors of QOL changes were examined and related to post-operative seizure outcome and likelihood of VNS generator replacement.ResultsAfter VNS therapy, physicians reported patient improvement in alertness (58–63%, range over follow-up period), post-ictal state (55–62%), cluster seizures (48–56%), mood change (43–49%), verbal communication (38–45%), school/professional achievements (29–39%), and memory (29–38%). Predictors of net QOL improvement included shorter time to implant (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1–1.6), generalized seizure type (OR, 1.2; 95% CI, 1.0–1.4), female gender (OR, 1.2; 95% CI, 1.0–1.4), and Caucasian ethnicity (OR, 1.3; 95% CI, 1.0–1.5). No significant trends were observed over time. Patients with net QOL improvement were more likely to have favorable seizure outcomes (chi square [χ²] = 148.1, p < 0.001) and more likely to undergo VNS generator replacement (χ² = 68.9, p < 0.001) than those with worsened/unchanged QOL.SignificanceVNS for drug-resistant epilepsy is associated with improvement on various QOL metrics subjectively rated by physicians. QOL improvement is associated with favorable seizure outcome and a higher likelihood of generator replacement, suggesting satisfaction with therapy. It is important to consider QOL metrics in neuromodulation for epilepsy, given the deleterious effects of seizures on patient QOL.     

Long term outcome of functional hemispherectomy for refractory epilepsy: Experience from a single center

BackgroundHemispherectomy has an established role as a treatment of last resort in patients with unilateral hemispheric lesions suffering from refractory epilepsy.MethodsSeven patients were evaluated at our Epilepsy Unit. We compared the seizure outcome at 6 months, 1, 2, 5 years post-surgery, as well as at end follow-up (mean 7.1 years) using Engel classification. Reduction of antiepileptic drugs (AEDs) was also assessed utilizing equal time frames.ResultsThe mean age of seizure onset was 5.4 years. Engel I was achieved in 5 patients at 6 months (71.4%). Engel at 1 year was predicted by the Engel at 6 months (p = 0.013) with a similar number of patients being classified as Engel I outcome. Engel at 2 years was also predicted by Engel at 6 months and at 1 year (p = 0.030). At end follow-up only 3 patients (42.9%) remained categorized as Engel I outcome. There was a trend toward a stability in Engel classification. All patients with developmental causes for their epilepsy experienced some deterioration of the surgical outcomes. Conversely, all patients with acquired causes were stable throughout follow-up. Seizure outcome at 6 months was worse in the patients who had post-op complications (p = 0.044). Adult and pediatric populations did not differ significantly in any tested variable.ConclusionsHemispherectomy is a valuable resource for seizure control in properly selected patients. Engel patient's evolution could be predicted at 6 months interval. Hemispherectomy could be considered a useful attitude in difficult cases.     

The effect of recurrent seizures on cognitive,behavioral, and quality-of-life outcomes after 12 months of monotherapy in adults with newly diagnosed or previously untreated partial epilepsy

PurposeThe purpose of this study was to determine whether seizure recurrence has a negative impact on cognition, psychological function, and health-related quality of life (HRQoL) over a 12-month period of monotherapy in adults with newly diagnosed or previously untreated partial epilepsy.MethodsSeizure freedom (SF) was defined as no seizure recurrence during the 40-week maintenance period of medication. Neuropsychological tests, the Symptom Checklist—90 (SCL-90), and the Quality of Life in Epilepsy—31 (QOLIE-31) were administered at baseline and after 48 weeks of carbamazepine or lamotrigine monotherapy. Seventy-three patients successfully continued treatment until the 48-week follow-up time point. Fifty patients (68.5%) had SF, and the remaining 23 were not seizure-free (NSF). A seizure outcome group-by-time interaction was analyzed using a linear mixed model.ResultsA group-by-time interaction was identified for the total QOLIE-31 score (p < 0.05) and score on two QOLIE-31 subscales (social function: p < 0.001 and seizure worry: p < 0.001), with a significant improvement over time only present in the SF group (all p < 0.001). There was no significant group-by-time interaction for most cognitive function tests, with the exception of the serial clustering score (p < 0.01) and number of recognition hits on the California Verbal Learning Test (p < 0.05). Serial clustering did not differ between the SF and NSF groups at baseline, but was significantly more used in the NSF group than in the SF group at 48 weeks (p < 0.01). There was no significant group-by-time interaction for any dimension of the SCL-90.ConclusionRecurrent seizures had a significant effect on HRQoL, a subtle effect on cognitive performance, and no effect on psychological symptoms over one year in newly diagnosed or previously untreated adults with partial epilepsy.     

Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy

Vagus nerve stimulation (VNS) is a widely used adjunctive treatment option for intractable epilepsy. Most studies have demonstrated short-term seizure outcomes, usually for up to 5 years, and thus far, none have reported psychosocial outcomes in adults. We aimed to assess long-term seizure and psychosocial outcomes in patients with intractable epilepsy on VNS therapy for more than 15 years. We identified patients who had VNS implantation for treatment of intractable epilepsy from 1997 to 2013 at our Comprehensive Epilepsy Program and gathered demographics including age at epilepsy onset and VNS implantation, epilepsy type, number of antiepilepsy drugs (AEDs) and seizure frequency before VNS implantation and at the last clinic visit, and the most recent stimulation parameters from electronic medical records (EMR). Phone surveys were conducted by research assistants from May to November 2014 to determine patients' current seizure frequency and psychosocial metrics, including driving, employment status, and use of antidepressants. Seizure outcomes were based on modified Engel classification (I: seizure-free/rare simple partial seizures; II: > 90% seizure reduction (SR), III: 50–90% SR, IV: < 50% SR; classes I to III (> 50% SR) = favorable outcome). A total of 207 patients underwent VNS implantation, 15 of whom were deceased at the time of the phone survey, and 40 had incomplete data for medical abstraction. Of the remaining 152, 90 (59%) were contacted and completed the survey. Of these, 51% were male, with the mean age at epilepsy onset of 9.4 years (range: birth to 60 years). There were 35 (39%) patients with extratemporal epilepsy, 19 (21%) with temporal, 18 (20%) with symptomatic generalized, 5 (6%) with idiopathic generalized, and 13 (14%) with multiple types. Final VNS settings showed 16 (18%) patients with an output current > 2 mA and 14 (16%) with rapid cycling. Of the 80 patients with seizure frequency information, 16 (20%) had a modified Engel class I outcome, 14 (18%) had class II, 24 (30%) had class III, and 26 (33%) had class IV. Eighty percent said having VNS was worthwhile. Among the 90 patients, 43 patients were ≥ 18 years old without developmental delay in whom psychosocial outcomes were further analyzed. There was a decrease in the number of patients driving (31% vs 14%, p = 0.052) and working (44% vs 35%, p = 0.285) and an increase in the number of patients using antidepressant medication (14% vs 28%, p = 0.057) at the time of survey compared to before VNS. In this subset, patients with > 50% SR (60%) were taking significantly fewer AEDs at the time of survey compared to patients with unfavorable outcomes (median: 3 vs 4, p = 0.045). The associations of > 50% SR with the psychosocial outcomes of driving, employment, and antidepressant use were not significant, although 77% of this subset said VNS was worthwhile.This is the first study that assesses both seizure and psychosocial outcomes, and demonstrates favorable seizure outcomes of > 50% SR in 68% of patients and seizure freedom in 20% of patients. A large majority of patients (80%) considered VNS therapy worthwhile regardless of epilepsy type and psychosocial outcomes.     

Neurologist assessment of reactions to the diagnosis of psychogenic nonepileptic seizures: Relationship to short- and long-term outcomes

PurposeTo determine the relationship between neurologist assessment of reactions to the diagnosis of PNESs and outcomes at 6–12 months and at 5–10 years.MethodsTwo hundred thirty-eight patients with psychogenic nonepileptic seizures (PNES) were recruited into a long-term follow-up study. At diagnosis and 6–12 months post diagnosis, doctors recorded their assessments of patient and caregiver reactions to the diagnosis of PNESs.ResultsAt baseline, 92/238 patients (38.7%) and 73/106 caregivers (68.9%) were assessed as having understood and accepted the diagnosis, while 6.7% of patients and 10.4% of caregivers reacted with anger. At 6–12 months, patient acceptance rose to 57.7%, with caregiver acceptance static at 70.8%. Attendance at follow-up was predicted by the presence of a caregiver at baseline: only one patient who came with a caregiver at baseline did not attend at 6–12 months (OR: 123.80, p < 0.001). Outcome at 6–12 months was predicted by patient acceptance at baseline (OR: 2.85, p = 0.006) and at 6–12 months (OR: 13.83, p < 0.001) and by caregiver acceptance at 6–12 months (OR: 10.77, p < 0.001). Presentation to primary or secondary care with attacks at 5–10 years was predicted by caregiver acceptance at 6–12 months (OR: 3.50, p = 0.007).ConclusionPatient understanding and acceptance of the diagnosis of PNESs are linked to outcome at 6–12 months. The beliefs of caregivers may be important for outcome in the longer term, particularly with respect to health-care use.     

Safety of video-EEG monitoring and surgical outcome in patients with mesial temporal sclerosis and psychosis of epilepsy

PurposeCortico-amygdalohippocampectomy (CAH) has become an important treatment option for patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS); it has resulted in a 60–70% seizure remission rate and significant quality of life (QOL) improvements. Video-electroencephalography (VEEG) monitoring has been widely used in epilepsy centers for pre-surgical evaluation. A major concern in epilepsy surgery is whether to consider CAH treatment in patients with psychosis of epilepsy (POE). This study analyzed the safety and adverse events (AEs) of VEEG monitoring and the post-surgical outcomes of patients with refractory TLE-MTS and POE who underwent CAH.MethodClinical, sociodemographic and VEEG data from 18 patients with TLE-MTS and POE were analyzed. Psychiatric evaluations were performed using DSM-IV and ILAE criteria. The seizure outcome was evaluated using Engel's criteria.ResultsTwo patients (11.2%) presented AEs that did not result in increased lengths of hospitalization. Of the 10 patients (55.5%) who underwent CAH, 6 (60%) became free of disabling seizures (Engel I). The psychiatric and QOL evaluations revealed improvements of psychotic symptoms (p = 0.01) and in Physical Health (p = 0.01) following surgery.ConclusionThese data reinforce that VEEG monitoring is a safe method to evaluate patients with refractory TLE-MTS and POE in epilepsy centers.     

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.     

A preliminary longitudinal study on the cognitive and functional outcome of bipolar excellent lithium responders

BackgroundNeurocognitive dysfunction in bipolar disorder represents a possible marker of underlying pathophysiology, but to date, most studies are cross-sectional and heterogeneous with regard to pharmacological treatments. In the present study we investigated the 6-year cognitive and functional outcome of a sample of euthymic excellent lithium responders (ELR).MethodA total sample of twenty subjects was assessed at baseline and 6 years later: ten diagnosed of bipolar disorder according to DSM-IV criteria and ten healthy matched controls. The sample size was enough to find statistical differences between groups, with a statistical power of 0.8. Bipolar patients were on lithium treatment during all this follow-up period and fulfilled ELR criteria as measured by the Alda scale. A neuropsychological test battery tapping into the main cognitive domains was used at baseline and at after 6-year of follow-up. Functional outcome was evaluated by means of the Functioning Assessment Short Test at study endpoint.ResultsRepeated measures multivariate analyses of variance showed that bipolar patients were cognitively impaired in the executive functioning, inhibition, processing speed and verbal memory domains (p < 0.03) compared to controls and such deficits were stable over time. Longer duration of illness and lower psychosocial outcome were significantly related to cognitive impairment (p < 0.05).ConclusionsCognitive dysfunction was present even in euthymic ELR. These deficits remain stable over the long term, and are basically associated with greater symptoms and poorer psychosocial adjustment.     

The effects of lifestyle modification and statin therapy on the circulatory markers for vascular risk in patients with epilepsy

Although long-term therapy with antiepileptic drugs can increase the risk of vascular diseases, there have been little attempts to reduce the increased vascular risk in patients with epilepsy. We conducted a prospective longitudinal study to assess the effects of lifestyle modification and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) therapy on the increased circulatory markers for vascular risk in patients with epilepsy. We recruited patients with increased vascular risk such as a history of vascular events or hypercholesterolemia, and they decided whether to be treated with statin or just to modify their lifestyle. The circulatory markers of vascular risk were measured twice before and after a 3-month intervention. A total of 78 patients completed the study, and 37 of them chose to be treated with statin. A 3-month intervention with statin results in significant decreases in homocysteine (p = 0.010) and uric acid (p = 0.015) as well as total cholesterol (p < 0.001) and low-density lipoprotein (LDL) cholesterol (p < 0.001). The lifestyle modification group experienced less prominent decreases in total cholesterol (p = 0.010) and LDL cholesterol (p = 0.012). There were no reports of serious adverse events or seizure aggravation related to the statin treatment. Our findings suggest that lifestyle education is necessary in patients with epilepsy with increased vascular risk and that treatment with statin would be a well-tolerated and effective option for these patients.     

Suicidal risk,affective dysphoric disorders,and quality-of-life perception in patients with focal refractory epilepsy

ObjectivesWe aim to study the frequency of (suicidal ideation) in patients with focal refractory epilepsy and its possible association with factors such as perceived QOL (quality of life) and ASDD (affective somatoform dysphoric disorder) using the 2007 ILAE proposal to classify affective disorders of epilepsy.MethodsA total sample of 82 patients was divided into two groups depending on the presence of suicidal risk: (A) study group — with suicidal risk and (B) control group — without suicidal risk. Questionnaires, scales, interviews, and clinical charts were evaluated by professionals with expertise in neurology and epileptology (RAM and AGA), psychiatry (AGE), and neuropsychology (FGR). Suicidal risk was evaluated with the M.I.N.I. (Mini-International Neuropsychiatric Interview) suicidal module that specifies the current suicidal risk based on scores. Quality of life was evaluated with the Quality of Life in Epilepsy Inventory — 31 (QOLIE-31) survey. Logistic regression was conducted to ascertain if ASDD and QOL significantly predicted suicidal risk. The results were considered statistically significant when the p-value was < 0.05.ResultsSuicidal risk was present in 33 (40.3%) patients. It was classified as severe in 31.7% of the patients, and it was only present in cases with temporal lobe epilepsy (p = 0.002). More than half (52%) of patients with ASDD had risk of suicide (p = 0.006). The presence of ASDD was found to be a risk factor for suicidal risk (OR = 3.86; IC = 1.3–12.2). Patients with suicidal risk had a lower QOL score compared with patients without suicidal risk (57.8 ± 16.9 vs. 46.0 ± 18.2; p < 0.05), and an affected QOL significantly increased suicidal risk (OR = 2.9; CI = 1.3–7.8). Multivariate analysis demonstrated that an impaired QOL (OR = 2.2) and the presence of ASDD (OR = 4.1) significantly increased the probability of having suicidal risk (x² = 13.6; OR = 5.2; p = 0.009).SignificanceAffective somatoform dysphoric disorder and low QOL perception increase, independently, the risk of suicide.