Socio-Demographic Influences on Epilepsy Outcomes in an Inner-City Population

PurposePrevious studies show anti-epileptic drug compliance and seizure control in people with epilepsy (PWE) to be lower among low-income groups and African-Americans. We examined how socio-demographic factors influence seizure control in an inner-city population.MethodsThe clinic records of 193 PWE were analyzed. Good seizure control was defined as no seizures in the previous year. Bivariate and multivariate analyses were performed to examine the effects of race, age, gender, median household income, medication cost, and insurance status on good seizure control.ResultsThere were 69 Caucasians and 124 African-Americans (age 47.8 ± 16.5 years) in the study. African Americans had a significantly lower income than Caucasians (p < 0.001); but did not have inferior seizure control (p = 0.18). Seizure control was also not affected by gender (p = 0.82), AED costs (p = 0.06), insurance type (p = 0.20), or race-independent household income (p = 0.75).ConclusionContrary to prior literature, we find that in our population of PWE there were no significant effects of race or family income on seizure outcomes. Our findings add to the existing literature on socio-demographic disparities in PWE and merit further exploration by other groups     

A randomized trial of polyunsaturated fatty acids for refractory epilepsy

ObjectiveThough polyunsaturated fatty acids (PUFA) reduce seizures in several animal models, results have been inconsistent in humans. The goal of the present study was to assess the effectiveness of a PUFA supplement as adjunctive treatment for intractable focal or generalized epilepsy in humans.MethodsAdults with uncontrolled epilepsy were randomized to either mineral oil placebo or a PUFA supplement (eicosapentanoic acid (EPA) plus docosahexanoic acid (DHA), 2.2 mg/day in a 3:2 ratio). Following a 4-week prospective baseline and 1-week titration, subjects entered a 12-week treatment period, followed by an optional 4-week open-label phase.ResultsOf 21 subjects (12 PUFA and 9 placebo), 0 on PUFA versus 2 on placebo had at least a 50% decrease in seizure frequency from baseline (P = 0.17). Overall, seizure frequency increased 6% on PUFA and decreased 12% on placebo (P = 0.21). During optional open-label administration, however, 15 of 19 subjects had fewer seizures than during baseline (P = 0.02).ConclusionsBased on the randomized, blinded portion of this study, the PUFA preparation used was not superior to placebo as adjunctive treatment for intractable epilepsy. It is not known whether different doses or different EPA:DHA ratios would be effective.     

The effect of vitamin B supplementation on homocysteine metabolism and clinical state of patients with chronic epilepsy treated with carbamazepine and valproic acid

PurposeTo investigate the influence of vitamin B supplementation on the plasma total homocysteine (p-tHcy), serum folate (s-FA), serum B12 (s-B12), and clinical state of patients with chronic epilepsy.MethodsBeck Depression Inventory (BDI) scores and p-tHcy, s-B12, and s-FA levels were assessed at baseline, after 1 year of supplementation (G1), and before and after 1 year of VPA or CBZ therapy (G2).ResultsEighty-one patients participated in the study: 51 patients with chronic epilepsy (G1) treated with carbamazepine (CBZ) or valproic acid (VPA), and 30 patients with newly diagnosed epilepsy (G2). At baseline, mean p-tHcy level was significantly higher in G1 than G2 (p = 0.0001) with no significant differences in s-FA or s-B12 levels. p-tHcy level significantly decreased in CBZ-treated G1 patients (p = 0.00002) after 1 year of supplementation and increased in G2 after 1 year of anti-epileptic drug (AED) therapy without supplementation. BDI scores in G1 decreased significantly after 1 year of supplementation (p = 0.0001) and increased significantly in VPA-treated G2 patients after 1 year of AED therapy (p = 0.02). The number of hyperhomocysteinemic patients significantly decreased in G1 after vitamin B supplementation (p = 0.01) and increased in G2 (p = 0.002). We also observed improved BDI scores and reduced seizure frequency in patients with chronic epilepsy.ConclusionsThese data support the hypothesis that AEDs play a major role in hyperhomocysteinemia development in patients with epilepsy. Adding folate and vitamin B12 to AED therapy is a safe and inexpensive way to reduce the risk of hyperhomocysteinemia.     

Significance of seizure in cerebral venous sinus thrombosis

PurposeTo report the frequency and predictors of presenting seizures in cerebral venous sinus thrombosis (CVST) and their influence on seizure recurrence and outcome.MethodsThis retrospective study, between 1995 and 2011, included 90 consecutive patients with CVST diagnosed using magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Clinical parameters like frequency, type (presenting, early, and late), and duration of seizures, precipitating causes of CVST, and underlying prothrombotic conditions, were recorded. The location of infarction on MRI and the number of sinuses involved on MRV, were noted. The patients were prescribed anticoagulants, and those with seizures were prescribed antiepileptic drugs. The patients were followed up at 3, 6, and 12 months. The functional outcome at 6 months was categorized into death, poor, partial and complete recovery.ResultsA total of 42 patients with CVST presented with seizures (focal 11, focal with secondary generalized 19, and generalized tonic clonic 16), of whom 10 had status epilepticus. On univariate analysis, supratentorial lesion (P = 0.005), frontal (P = 0.02) or parietal lobe (P = 0.04) involvement and haemorrhagic lesion (P = 0.002) were associated with higher risk of presenting seizure. On multivariate analysis, only supratentorial parenchymal lesion on MRI (odds ratio [OR] = 4.67, 95% confidence interval [CI] 1.51–15.08, P = 0.005) was independently associated with higher risk of presenting seizure. Only 4 patients had early seizures and none had late seizures. At 6 months, 10 patients died and 73 patients had complete recovery. Seizures were not associated with death (P = 1.00) and 6-month functional outcome (P = 0.66).ConclusionAbout half the patients with CVST had presenting seizures which was independently related to supratentorial lesion. However, seizures were not related to death or 6-month outcome.     

An estimate of placebo effect of repetitive transcranial magnetic stimulation in epilepsy

ObjectiveLow-frequency repetitive transcranial magnetic stimulation (rTMS) is emerging as a therapeutic tool in epilepsy. In recent years, several open-label trials have shown an encouraging reduction in seizure frequency in patients with epilepsy. However, the data from controlled trials are mixed with respect to antiepileptic rTMS efficacy, and the field would benefit from further carefully controlled trials. Prior to initiating new trials, it is important assess the magnitude of the placebo effect of presently used sham rTMS methods.MethodsWe systematically analyzed individual subject data from three placebo-controlled trials and measured the placebo effect at follow-up intervals of 2, 4, and 8 weeks after sham rTMS treatment. Given the relatively small subgroup sample size, placebo condition data were pooled for analysis.ResultsThree methods for sham rTMS were employed in the reviewed studies: (1) coil positioning orthogonal to the scalp, (2) a spring-loaded sham coil, and (3) a double active-sham coil. The placebo response overall was consistently low across follow-up intervals, both for median change in seizure frequency (Kruskal–Wallis, P > 0.4, df = 2) and for responder (defined as ≥ 50% seizure frequency reduction) rate (Fisher's exact rest, P > 0.9, df = 2). The aggregate effect of the placebo condition was a 0–2% median seizure reduction rate and a responder rate of 16–20%.ConclusionWe anticipate that these data will contribute to future power analysis as well as selection and design of sham rTMS methods for controlled rTMS trials.     

Self reported adverse effects of mono and polytherapy for epilepsy

PurposeAdverse effects of anti epileptic drugs (AEDs) can significantly affect the life of people with epilepsy. We used a register to determine if polytherapy with AED has more adverse effects than monotherapy.MethodsWe established a register for people with epilepsy (www.UKAED.info). Participants were requested to complete the Liverpool Adverse Event Profile (LAEP) to quantify adverse effects. We also recorded type of epilepsy, seizure control and AED including drug doses. Five hundred and seventy six complete data sets were available, monotherapy (n = 186), polytherapy (n = 325) and control subjects not taking AED (n = 65).ResultsThe mean LAEP scores in polytherapy (45.56, confidence interval (CI) = 44.36–46.76) were significantly higher than the mean LAEP scores in monotherapy (42.29, CI = 40.65–44.02) and the mean LAEP scores in controls (33.25, CI = 31.05–35.44). Tiredness, memory problems and difficulty concentrating were the most common symptoms in patients taking AED and were consistently higher in polytherapy than in monotherapy. Tiredness was reported as always or sometimes being a problem in (polytherapy/monotherapy/controls) 82.5%/75.6%/64.6%, memory problems in 76%/63.2%/29.2% and difficulty concentrating in 68%/63.9%/30.8%. The proportion of seizure-free patients was significantly lower in the polytherapy group (17%) than in the monotherapy group (55%). Depression rates between the monotherapy and polytherapy groups were similar. Drug dosages were higher in polytherapy, however this did not reach statistical significance.ConclusionPatients on polytherapy had significantly higher LAEP scores than patients on monotherapy. This should be carefully discussed with the patient before a second AED is added.     

Anxiety symptoms in patients with frontal lobe epilepsy versus generalized epilepsy

PurposeThe aim of this study was to compare the frequency of anxiety symptoms between patients with frontal lobe epilepsy (FLE) and generalized epilepsy (GE).MethodsForty and 78 patients with FLE and GE respectively were enrolled in the study. Anxiety symptoms were measured with the Hamilton anxiety rating scale (HARS) and the anxiety subscale of the hospital anxiety and depression scale (HADSA).ResultsCompared to the GE group, the FLE group had significantly higher HARS (10.9 ± 8.7 vs. 7.9 ± 6.8, p = 0.039) scores. Significant correlations were also found between anxiety symptoms and epilepsy-related variables, particularly with the seizure frequency and the number of currently taken anti-epileptic drugs.ConclusionAnxiety symptoms are more common in patients with FLE in comparison to those with GE. Further studies are warranted to clarify the relationship between anxiety symptoms and FLE.     

Seizure frequency in children with epilepsy: Factors influencing accuracy and parental awareness

RationaleThe objective of this study was to ascertain the accuracy of clinical reports to determine the seizure frequency in children diagnosed with epilepsy.MethodsWe reviewed the clinical record of 78 children (January–May of 2006) admitted to the EEG–video monitoring with epilepsy diagnosis. Clinical reports of parents and the files of EEG–video monitoring were reviewed to determine parents’ awareness for seizures.ResultsDuring video–EEG monitoring, 1244 were recorded on 78 children. Seizures were confirmed in 1095 of which 472 were correctly reported (38%) by parents whereas 623 remained under-reported (50%). Parents’ report thus had a sensitivity of 43%, positive predictive value of 76% to identify seizures. Based on the EEG–video monitoring, seizures were reported accurately in 22 (28%) and under-reported in 38 (49%) children. In the under-reported group, none of the seizures were recognized in 10 (13%), only a portion identified in 28 children. The parents’ report describing seizure frequency has limited value for young children (p = 0.01) and children with absence seizures (p = 0.03). However, clinical reports were accurate for the children with developmental delay (p < 0.06) or not being on any anticonvulsant drug (AED) therapy (p = 0.02).ConclusionOur results indicate that a significant number of seizures remain under-reported by parents of children with epilepsy. The current study underscores that the seizure frequency should be interpreted with caution for young children and children with absence seizures. Video–EEG recording has a complimentary role to the clinical observation for the accurate assessment of seizure frequency in children.     

Metabolic syndrome among Chinese obese patients with epilepsy on sodium valproate

BackgroundMany publications have addressed the problem of weight gain and endocrine abnormalities in patients treated with sodium valproate (VPA). However, the presence of metabolic syndrome (MetS) among obese patients with epilepsy on VPA has received little attention.MethodsThirty-six patients receiving VPA monotherapy were included in this study to evaluate the presence of MetS. All patients were interviewed and clinically examined. Blood samples were obtained after an overnight fast, and an oral glucose-tolerance test was performed. Twenty-eight subjects who were obese but had no epilepsy and were otherwise well were collected as controls (“simple obesity” group).ResultsThe two study groups were well matched in terms of age, gender and body mass index. Insulin resistance measured via homeostasis model assessment (HOMA) index was more severe among the VPA-treated group (4.91 ± 2.91 vs. 2.00 ± 1.72, P = 0.007). The frequency of the MetS was slightly higher in the patients with epilepsy compared to controls (47.2% vs. 32.1%, respectively), but this difference was not statistically significant (P = 0.223). Multivariate analysis with stepwise logistic regression revealed low positive correlations between MetS development, HOMA index (P = 0.029; r = 0.361) and valproic acid dose (P = 0.049; r = 0.323). These correlations were independent of other clinical parameters.ConclusionsOur preliminary study suggests that obese patients with epilepsy treated with VPA are at higher risk of MetS than individuals who are “simply obese” but otherwise well. Therefore, the HOMA index should be monitored in obese patients who receive VPA therapy, rather than monitoring body weight alone.     

Validation of Chinese version of the Morisky Medication Adherence Scale in patients with epilepsy

PurposeThis study aimed to validate a Chinese version of the Morisky Medication Adherence Scale (MMAS-8) in patients with epilepsy. The relationships between adherence, seizure frequency, and adverse effects were assessed using this method.MethodsData from patients diagnosed with epilepsy at the Department of Neurology of Huashan Hospital were collected between January and June 2013. To validate the MMAS-8, internal consistency, test–retest reliability, and factor analysis were calculated. Relationships between adherence, seizure frequency, and adverse effects were assessed using Pearson's correlation.ResultsOne hundred and eleven patients were recruited. The MMAS-8 had moderate internal consistency (Cronbach's α = 0.556) and good test–retest reliability (intraclass correlation coefficient = 0.729). The MMAS-8 adherence rate was 79.2%. MMAS-8 adherence was negatively correlated with seizure frequency and adverse effects (r = –0.708, p < 0.001; r = –0.484, p < 0.001).ConclusionThe MMAS-8 scale can be used as a tool to assess medication adherence in Chinese patients with epilepsy. Better seizure control and lower rates of adverse effects were significantly correlated with higher adherence scores.     

Sleep before and after temporal lobe epilepsy surgery

PurposePatients with epilepsy often complain of non-restorative sleep. This is the consequence of the acute effect of seizures and the chronic effect of epilepsy responsible for disrupting sleep architecture. Other factors such as antiepileptic drugs (AEDs), also play a role in the alteration of sleep organization. The aim of this study was to evaluate the specific effect of seizures and interictal epileptiform abnormalities (IEAs) on sleep, in particular to see whether reducing seizure frequency by epilepsy surgery might improve sleep organization in these patients.MethodsEleven patients with refractory mesial temporal lobe epilepsy, who underwent surgical treatment and who were seizure free at the follow-up, were included in the study. Treatment with AEDs was not significantly modified before the second year of follow-up. Patients were evaluated before surgery, at 1-year and 2-year follow-up visits with a videoEEG monitoring (24 h/24). At each follow-up visit, interictal epileptiform abnormalities and sleep macrostructure parameters were assessed.ResultsAll patients showed a reduction of their IEAs. At 1-year follow-up, total sleep time and REM sleep increased significantly (p = 0.032 and p = 0.006, respectively). At 2-year follow-up, an important increase of REM sleep was observed (p = 0.028). Most significant variations were noted 1 year after surgery. No significant variations were observed between the first and the second year after surgery.ConclusionsSurgical treatment of temporal lobe epilepsy may improve sleep macrostructure by reducing the number of seizures and of IEAs. These results indirectly confirm the role of epilepsy in disrupting sleep organization chronically.     

Seizures during intracarotid methohexital and amobarbital testing

BackgroundMethohexital and amobarbital have been used as agents for Wada testing in the presurgical evaluation of patients with epilepsy. Previous experience with methohexital as an anesthetic indicates that methohexital may decrease seizure threshold and may trigger seizures.MethodsA retrospective chart review of 760 intracarotid amobarbital and methohexital tests was performed to determine the frequency of seizures associated with preoperative intracarotid barbiturate testing for language and memory lateralization.ResultsSixteen patients (2.1%) who had seizures were found. In 3 patients, seizures occurred prior to barbiturate injection, and in 13, following barbiturate injection. After injection of amobarbital, 4 of 538 patients (0.7%) had a seizure. Nine of 222 patients had a seizure after methohexital injection (4.1%) (P = 0.001).ConclusionPatients with a previous history of epilepsy may be at higher risk for seizures after methohexital injection as compared with amobarbital injection.     

Physical injuries in patients with epilepsy and their associated risk factors

ObjectivesTo determine the frequency, nature, and risk factors associated with physical injuries in patients with epilepsy.MethodsIn this retrospective cohort study, patients 18 years of age and older with active epilepsy for at least 1 year were included. A questionnaire (including age, gender, education, type of epilepsy, seizure frequency, having aura, drug compliance, polypharmacy, comorbidity, type and place of injury) was completed from patients and healthy individuals. Statistical analyses were performed using multiple logistic regression and Chi-square tests.Results264 patients with epilepsy and 289 healthy participants were studied. Among patients, 8.7% reported severe injuries and 44.3% had mild injuries. Most patients reported soft tissue injuries, followed by dental injury, burn, and head injury. Severe injuries were 2.9 times more frequent among patients having generalized tonic–clonic seizures (GTCS) compared to healthy control; this was not statistically significant (P = 0.07). No patient reported having severe injuries due to SPS, myoclonic or absence seizures. Mild injuries were 10.3 times more frequent among those with GTCS compared to healthy control (P = 0.001). The relative risk for having injury in patients compared to control group was 3.42 (95% confidence interval: 2.50–4.69). Injury was significantly related to having GTCSs, illiteracy, having fall with seizures, comorbidity and having uncontrolled seizures.ConclusionPhysical injuries are common in patients with epilepsy; however most of these injuries are mild. Severe injuries rarely occur in patients with seizures other than GTCS.     

Effect of successful epilepsy surgery on subjective and objective sleep parameters – a prospective study

ObjectiveTo evaluate the effect of surgery on subjective and objective measures of sleep quality among patients with medically refractory focal epilepsy.MethodsIn a prospective cohort study, patients with medically refractory epilepsy undergoing epilepsy surgery were recruited. All patients were assessed seven days pre- and three months post-surgery in terms of history pertaining to epilepsy and sleep, Epworth sleepiness score (ESS), one week sleep log and over night polysomnography (PSG).ResultsAmong 17 patients (mean age 18, 11 males), seizure frequency had reduced (p = 0.04) and self reported sleep parameters had significantly improved (reduced total duration of night time sleep, regularity on one week sleep log and ESS (p < 0.05)) three months following epilepsy surgery. Patients with good surgical outcome (n = 12) showed reduced seizure frequency (p = 0.01) and reduced ESS with corresponding reduction in arousal index (AI) (p = 0.02) and increase in total sleep time (p = 0.03), postoperatively. Three patients in the good surgical outcome group showed reduction in apnea–hypopnea index (AHI) from more than five to less than five. There was no significant change either in seizure frequency, self reported clinical parameters or PSG parameters among patients with poor surgical outcome.ConclusionEpilepsy surgery improves subjective sleep parameters in patients with medically refractory epilepsy during the early post operative period. Successful epilepsy surgery may improve objective (PSG documented) sleep quality, sleep architecture and obstructive sleep apnea with resultant reduction in excessive daytime sleepiness.     

Safety,Awareness, and Familiarity regarding Epilepsy in Teenage Years (SAFETY): Understanding the adolescents' perspective about their disease

ObjectiveThe objective of this study was to evaluate the understanding of adolescent patients regarding epilepsy.MethodsThe SAFETY (Safety, Awareness, and Familiarity regarding Epilepsy in Teenage Years) questionnaire (content validity index: 0.96, Flesch readability score: 66.6) was administered to 165 cognitively normal adolescents with epilepsy (85 females, mean age: 15.2 ± 1.6 years, range: 13–18 years). The first part of the questionnaire was devised to evaluate knowledge about epilepsy and antiepileptic medications (SAFETY-K: 7 questions). The second part queried lifestyle modifications and safety (SAFETY-S: 10 questions). Female participants answered 5 additional questions related to reproductive health (RH questionnaire).ResultsThe correct response rate for the composite SAFETY questionnaire was 51.5%. The average rates of correct responses for the SAFETY-K and SAFETY-S questions were 47.9% and 53.9%, respectively. On univariate logistic regression analysis, factors which were significant predictors of correct responses included age (odds ratio: 1.8, C.I. = 1.3–2.4), race (Caucasian vs. African-American; odds ratio: 3.9, C.I. = 1.4–10.4), and employment of at least one parent in a professional occupation (odds ratio: 3.3, C.I. = 1.1–10.3). The correct response rate did not correlate with the duration of epilepsy, extent of seizure control, number of antiepileptic medications, parental educational, or (un)employment status. The mean rate of correct responses for the RH questions amongst teenage girls was 17.4%.ConclusionsThere is lack of awareness about epilepsy and its associated lifestyle modifications in adolescents with epilepsy seen at our institution. This is especially true in young adolescents, African-American patients, and those whose parents are not employed in professional occupations. Teenage girls with epilepsy appear to have limited knowledge with respect to contraception and childbearing.     

Ictal high-gamma oscillation (60-99 Hz) in intracranial electroencephalography and postoperative seizure outcome in neocortical epilepsy

ObjectiveHigh-gamma oscillations (HGOs) (60–99 Hz) have been suggested to correlate with seizure onset zones and seizure outcomes. We investigated the correlation between the extent of removal of ictal HGO generating areas and postoperative seizure outcome in neocortical epilepsy (NE).MethodsTwenty three patients with medically intractable NE underwent chronic intracranial electroencephalography (iEEG) using subdural electrodes. Ictal HGOs and superimposed undersampled ripples within ±3 s of video-iEEG ictal onset were extracted by wavelet clustering and thresholding. Cluster epileptogenicity indices (CEIs) were calculated. The temporal analysis window was locked to the timing of the maximum CEI wavecluster. Root mean square amplitudes, cross-correlation synchronies and the local focus indices within the temporal window were calculated.ResultsPercentages of resected maximum CEI waveclusters and HGO zones with high standardised amplitudes (>3), high cross-correlation synchronies (>0.9) and high local focus indices (>2) were significantly higher in the seizure-free group compared to the not seizure-free group (p = 0.036, p = 0.018, and p = 0.026, respectively).ConclusionsThe automatic quantitative ictal HGO analysis may be effective in delineating the epileptogenic zone.SignificanceHGO analysis may be helpful for improving post-resection seizure outcome in NE in the future.     

Severity of anxiety and depression are related to a higher perception of adverse effects of antiepileptic drugs

After reviewing the negative effects of antiepileptic drugs (AEDs) on general health and quality of life, the Commission on Outcome Measurement from the International League Against Epilepsy (ILAE) recommended incorporating reliable and valid tools in clinical essays in order to achieve a more accurate assessment of the subjective adverse effects rate and disease severity when using AEDs.PurposeThe aim of this study was to correlate the severity of adverse effects of AEDs, with the presence of anxiety and depression in patients with epilepsy.MethodsThe Spanish version of the Liverpool Adverse Events Profile (LAEP) and the Hospital Anxiety and Depression Scale (HADS) were applied on 130 consecutive outpatients with epilepsy from the epilepsy clinic at the Mexico's National Institute of Neurology and Neurosurgery. A correlation analysis was carried out to determine if the presence of depression and anxiety was related to the adverse effects of AEDs. The relation between LAEP scores with other epidemiological variables was also assessed.ResultsOur study found a positive correlation between the LAEP and the HADS scores (p = <0.01).The most common adverse effects were drowsiness (81.5% [n = 106]), difficulty in concentrating (76% [n = 99]), and nervousness and/or agitation (75% [n = 97]). Female gender, a history of febrile seizures, persistent seizures and polytherapy were associated with a higher toxicity on LAEP. In our study, age at epilepsy onset, duration of epilepsy, type of epilepsy and patients’ age were not related to higher LAEP scores.ConclusionAdverse effects to AEDs can be related with the presence of psychiatric disorders such as anxiety and depression in patients with epilepsy.     

Awareness,attitudes toward epilepsy,and first aid knowledge of seizures of hospital staff in Henan,China

AimThe aim of this study was to evaluate awareness of, attitudes toward, and first aid knowledge of seizures of hospital staff in Henan, China.MethodTwo hundred nineteen hospital staff, including doctors, nurses, medical technicians, logisticians, and executives working at tertiary hospitals in Henan, China, completed the survey from March to September in 2016. The data comprised the demographic data section, awareness of epilepsy section, attitude toward epilepsy section, and first aid knowledge of seizure attack section.ResultsThe participants obtained a mean score of 7.48 ± 1.705 on the awareness of epilepsy section, and a mean score of 5.32 ± 1.165 on the first aid knowledge of seizure attacks section. There were significant correlations between educational level (r = 0.187, P = 0.006), occupation (r = − 0.244, P = 0.000), and attitudes toward patients with epilepsy (r = 0.351, P = 0.000) with the awareness of epilepsy. There were significant correlations between age (r = 0.170, P = 0.014), educational status (r = 0.139, P = 0.040), and professional titles (r = 0.197, P = 0.004) with the first aid knowledge of seizures.ConclusionThe study showed that hospital staff had a moderate level of knowledge regarding epilepsy, and they generally displayed a positive attitude. It was also determined that as the awareness of epilepsy increased, they displayed more positive attitudes toward patients with epilepsy. The study also suggests that specialists working on epilepsy should provide more lectures and educational sessions to improve the knowledge of and attitude toward epilepsy and first aid knowledge of seizures among hospital staff.     

Feasibility and acceptability of smartphone applications for seizure self-management in China: Questionnaire study among people with epilepsy

ObjectiveThe aim of this report was to assess the feasibility and acceptability of using smartphone apps for seizure self-management in China.MethodsAll patients with epilepsy were consecutively recruited from the Neurology Epilepsy Prevention and Cure Center of West China Hospital from January 2015 to June 2015. Data on patients' clinical characteristics, mobile phone utilization habits, preferences for contents of apps for seizure self-management, medication adherence, and attitudes toward the use of smartphone apps were collected from 502 patients with epilepsy by questionnaire.ResultsAmong 502 participants, 96.8% had their own mobile phones, and 94.4% owned a smartphone. Although only 9.5% (48/502) of participants had prior knowledge of apps for managing chronic illness, 66.7% (335/502) of participants reported that managing their seizure through an app would be useful. Sixty-five point five percent of participants reported that they would use a smartphone app for seizure self-management if it were free. Patients who were more likely to use an app were those with a low Morisky Scale score (patients with poor medicine adherence), young patients, patients who lived in cities, and patients with frequent seizures (P < 0.001, P = 0.002, P < 0.001, P = 0.01). Patients with higher education and with stable employment were also more likely to use an app (P = 0.001, P < 0.001).ConclusionsThis is the first study on the feasibility and acceptability of smartphone apps for seizure self-management in China. The findings of this study indicate that there is a positive attitude toward using epilepsy apps among patients with epilepsy. Based on patients' positive attitudes toward using epilepsy apps and the current development of mobile health in China, the use of smartphone apps could be a promising strategy for seizure self-management.     

Impact of planning of pregnancy in women with epilepsy on seizure control during pregnancy and on maternal and neonatal outcomes

PurposeTo investigate whether planning of pregnancy in women with epilepsy affects seizure control during pregnancy and to compare the maternal and neonatal outcomes in planned and unplanned pregnancies.MethodsThis was a retrospective cohort study of 153 pregnant women with epilepsy who were treated at the University of Tsukuba Hospital and Hokkaido University Hospital between 2003 and 2011. Twenty-one pregnancies were excluded due to insufficient data. Data of patients followed by neurologists during their planned pregnancies (planned-pregnancy group, n = 51) were compared to those of patients referred to neurologists after conception for managing epilepsy during pregnancy (unplanned-pregnancy group, n = 81). The treatment profile for epilepsy, seizure control, and maternal and neonatal outcomes in both groups were compared using Chi-square test or Fisher's exact test and Mann–Whitney U test.ResultsCompared to the unplanned-pregnancy group, the planned-pregnancy group showed a significantly greater proportion of patients receiving monotherapy with antiepileptic drugs (80% vs. 61%: planned vs. unplanned, P = 0.049) and those not requiring valproic acid (77% vs. 56%, P = 0.031). Furthermore, the frequency of epileptic seizures (16% vs. 35%, P = 0.018) and changes in antiepileptic drugs (24% vs. 41%, P = 0.042) were significantly lower in the planned-pregnancy group than in the unplanned-pregnancy group. No significant intergroup differences were noted in the obstetric complications and neonatal outcomes, including congenital malformations.ConclusionFor women with epilepsy, planning of pregnancy is associated with good seizure control during pregnancy and less fetal exposure to antiepileptic drugs.