Clinical factors associated with post-ictal headache in patients with epilepsy

OBJECTIVES: To determine the incidence of post-ictal headaches (PIH) and clinical risk factors associated with the occurrence of PIH in patients with localization-related epilepsy. MATERIALS AND METHODS: The subjects were 77 patients with temporal lobe epilepsy (TLE), 34 patients with occipital lobe epilepsy (OLE), and 50 patients with frontal lobe epilepsy (FLE). The subjects were directly asked whether headaches occurred just after seizures. Medical charts were reviewed to ascertain the clinical characteristics of epilepsy in these patients. RESULTS: The incidence of PIH was 23% for TLE, 62% for OLE, and 42%, for FLE. The risk of PIH was significantly higher for OLE than for TLE or FLE, and for patients with generalized tonic-clonic seizures. Younger age at onset of epilepsy was also a risk factor for PIH. CONCLUSION: The occurrence of PIH may be related to the region of epileptic focus and the region of spread of epileptic discharges.     

缺血性卒中伴发癫(癎)的危险因素分析

目的 探讨缺血性卒中伴发癫(癎)的危险因素,以加强早期预防并改善预后.方法 根据斯堪地那维亚卒中评分(SSS)对101例发病<24 h的缺血性卒中伴发癫(癎)患者进行神经功能缺损程度评价,同时记录患者性别,年龄,既往史(高血压、冠心病、心房纤颤、2型糖尿病、高脂血症),电解质(血清钾、钠、氯),发病状态(安静、活动),缺血性卒中亚型(动脉粥样硬化性血栓性脑梗死、脑栓塞、腔隙性梗死),脑梗死后渗血,病灶部位(脑叶、基底节区),受累大脑半球侧别(左侧、右侧、双侧),脑萎缩及脑白质脱髓鞘病变等临床资料,分别进行单因素分析和多因素非条件Logistic回归分析.结果 单因素分析显示,与单纯缺血性卒中患者相比,缺血性卒中伴发癫(癎)者缺血性卒中亚型(脑栓塞)、脑梗死后渗血、病灶部位(脑叶,其中额叶所占比例达48.72%)、受累大脑半球侧别(右侧),以及神经功能缺损程度(SSS评分<30分)均存在明显差异(均P≤0.05);而性别、年龄、既往史、电解质指标、发病时状态、脑萎缩程度、脑白质脱髓鞘病变等因素,两组差异无统计学意义(均P>0.05).多因素非条件Logistic回归分析表明,脑栓塞(OR=0.152,95%CI:0.065～0.496;P=0.011)、脑梗死后渗血(OR=0.105,95%CI:0.020～0.549;P=0.008)、脑叶皮质受累(OR=0.099,95%CI:0.044～0.225;P=0.000)、SSS评分<30分(OR=0.145,95% CI:0.062～0.337;P=0.000)等因素为缺血性卒中伴发癫(癎)的主要危险因素,而右侧大脑半球受累(OR=0.638,95%CI:0.311～1.308;P=0.220)则不增加缺血性卒中伴发癫(癎)的风险.结论 具有脑栓塞、脑梗死后渗血、病灶位于脑叶(特别是额叶)、SSS评分<30分等因素的缺血性卒中患者易伴发癫(癎).     

合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素分析

目的探讨合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素。方法回顾性分析2015年6月至2019年1月手术治疗的80例合并癫痫的幕上低级别胶质瘤的临床资料。术后1年,采用Engel分级评估癫痫预后,Ⅰ级为预后良好,Ⅱ~Ⅳ级为预后不良。用多因素logistic回归分析检验影响癫痫预后的影响因素;受试者工作特征(ROC)曲线分析术前癫痫发作频率预测癫痫预后的价值。结果80例中,术后癫痫预后良好59例,预后不良21例。多因素logistic回归分析结果显示,异柠檬酸脱氢酶(IDH)1突变和术前癫痫发作频率高是胶质瘤病人术后癫痫的独立危险因素(P<0.05),全切肿瘤和术后化疗是保护性因素(P<0.05)。术前癫痫发作频率预测癫痫预后的ROC曲线下面积为0.805(95%置信区间0.685~0.914;P<0.05);当术前癫痫发作频率≥2次/月时,预测术后癫痫预后不良的灵敏度和特异度分别为92.86%和46.85%。结论IDH1突变和术前癫痫发作频率高是合并癫痫的幕上低级别胶质瘤病人癫痫预后不良的危险因素,而肿瘤全切除和术后化疗明显改善癫痫预后。     

Driving prevalence and factors associated with driving among patients with epilepsy

PURPOSE: The goal of the work described here was to determine the prevalence of driving and associated variables among patients followed at a level 4 epilepsy center. METHOD: A survey was mailed out to patients seen at the University of Florida/Jacksonville Comprehensive Epilepsy Program. RESULTS: The study population comprised 308 respondents. Nearly 20% of patients with poorly controlled seizures continued to drive. Although several demographic and clinical variables were associated with driving, on univariate analysis, using multiple logistic regression, being employed, not receiving disability benefits, having less frequent seizures, and taking fewer antiepileptic drugs were the variables independently associated with driving. A subset analysis of patients with poorly controlled seizures indicated that being employed was still an independent factor associated with driving, along with higher annual household income and absence of convulsions and waking seizures. CONCLUSION: A significant number of patients with poorly controlled seizures drive. Being employed is a major reason these patients continue to drive.     

伴颅脑损伤的多发伤病死率的影响因素分析

目的 探讨伴颅脑损伤（TBI）的多发伤病死率的危险因素。方法 回顾性分析2012年4月至2017年4月收治的638例伴TBI的多发伤的临床资料,采用多因素Logistic回归分析检验危险因素。结果 638例中,死亡99例,病死率为15.52%。多因素Logistic回归分析显示合并基础疾病、收缩压≤60 mmHg、创伤严重度评分≥25分、GCS评分≤8分、多发伤创伤数量>4处、受伤至入院时间≥4 h,以及合并休克、全身性炎症反应综合征、多器官功能不全综合征、急性呼吸窘迫综合征为伴TBI的多发伤病人病死率的独立危险因素（P<0.05）。结论 伴TBI的多发伤病死率较高,影响因素很多,临床应加强监测,并采取有效的救治措施。     

Clinical factors associated with postictal headache in Chinese patients with partial epilepsy

PurposeTo investigate the incidence of postictal headache (PIH) and the factors potentially related to the occurrence of PIH in a Chinese epileptic center.MethodsConsecutive adult patients with epilepsy, referred to the outpatient clinic of the Epilepsy Center of the PLA General Hospital between February 01, 2012, and May 10, 2013, were recruited to this study. 854 patients with partial epilepsy completed a questionnaire regarding headache, 466 patients with temporal lobe epilepsy (TLE), 82 patients with occipital lobe epilepsy (OLE) and 306 patients with frontal lobe epilepsy (FLE). A semi-structured interview was performed in those who confirmed headache.ResultsPIH occurred in 328 (38.41%) of the subjects. By type of epilepsy, PIH was found in 164 (35.19%) of the patients with TLE, 46 (56.01%) of the patients with OLE, and 118 (38.56%) of the patients with FLE. The incidence of PIH in OLE was significantly higher than in TLE and FLE (P < 0.05). It occurs more frequently after generalized tonic–clonic seizures than other seizure types. Logistic regression analysis revealed that age at onset, type of seizure and classification of epilepsy were each significantly related to the occurrence of PIH.ConclusionThe results of our study revealed possible relationships between PIH and the region of epileptic focus and area of spread of epileptic discharges.     

Psychosocial factors associated with medication adherence in ethnically and socioeconomically diverse patients with epilepsy

The current study examined psychosocial correlates of medication adherence in a socioeconomically and racially diverse sample of patients with epilepsy. Fifty-five patients with epilepsy completed standardized self-report questionnaires measuring depression, stress, social support, and medication and illness beliefs. Antiepileptic drug (AED) adherence was measured using the 8-item Morisky Medication Adherence Scale 36% reported poor adherence. We tested which psychosocial factors were independently and most strongly associated with AED adherence. Stress and depression were negatively correlated with adherence, while perceived social support was positively correlated with adherence (Ps < .05). When all three of these variables and relevant covariates in a multiple regression model were included, only perceived social support remained a significant predictor of adherence (P = .015). This study is one of the first to suggest the importance of targeting social support in screening and intervention approaches in order to improve AED adherence among low-income, racially/ethnically diverse patients with epilepsy.     

成年癫痫患者的自杀风险及相关危险因素研究

目的：研究成人癫痫患者自杀风险及相关危险因素。方法采用简明国际神经精神访谈（MINI）自杀风险模块和抑郁障碍模块对211例我院门诊的成年癫痫患者进行心理评估,并详细记录患者的年龄、性别、就业状况、婚姻、教育年限、发病年龄、病程、发作类型、发作频率、头颅M RI结果以及使用抗癫痫药种数,比较上述因素与自杀风险的关系。结果本组病例中有自杀风险的患者占21.3％（45/211）,伴抑郁障碍的患者占17.1％（36/211）;而伴抑郁障碍患者的自杀风险高达75.0％（27/36）,非抑郁障碍患者的自杀风险达10.3％（18/175）,差异有统计学意义（χ2＝74.525,P＜0.01）。结论伴抑郁障碍的癫痫患者自杀风险更高。     

Prevalence of some risk factors in children with epilepsy compared to their controls.

AIM: The goal of this case-control study was to identify the significance of certain risk factors for epilepsy in Turkey. METHOD: A total of 805 cases, aged 1-16 years, followed-up for epilepsy at the Pediatric Neurology Department and a control group consisting of 846 age-matched cases without epilepsy were included in the study. The risk factors examined were gender, neurological impairment, febrile convulsion, head trauma, central nervous system infections, parental consanguinity, family history of epilepsy, prenatal and natal risk and newborn jaundice. Data regarding the investigated epilepsy risk factors were obtained through a questionnaire via personal interviews and the medical records and were assessed using univariate and multivariate analysis. RESULT: Univariate analysis showed an increased risk for epilepsy with a history of atypical febrile seizure (21.97-fold), severe and moderate head injury (27.76- and 7.09-fold respectively), CNS infection (4.76-fold), history of epilepsy in first-, second- or third-degree relatives (6.42-, 3.09- and 2.66-fold, respectively), presence of maternal hypertension (4.31-fold), an apgar score < or =6 at any time (7.78-fold) and neonatal jaundice (3.12-fold). Abnormal neurological signs increased the epilepsy risk 5.92 times in univariate analysis and 30.26 times in multivariate analysis. CONCLUSION: The most important risk factors for epilepsy in this study were neurological impairment, history of atypical febrile seizures, severe head injury and a low apgar score. Other important risk factors were moderate head trauma and a history of epilepsy in the family.     

Sociodemographic and clinical factors associated with depression in epilepsy

The impact of mood disorders on patients with epilepsy is an important and growing area of research. If clinicians are adept at recognizing which patients with epilepsy are at risk for mood disorders, treatment can be facilitated and morbidity avoided. We completed a case–control study (80 depressed subjects, 141 nondepressed subjects) to determine the sociodemographic and clinical factors associated with self-reported depression in people with epilepsy. The Patient Health Questionnaire-9 was used to determine clinically significant depression. In multivariate analyses, depressed subjects with epilepsy were significantly less likely than nondepressed subjects to be married or employed and more likely to report comorbid medical problems and active seizures in the past 6 months. Adjusted for all other variables, subjects with epilepsy reporting lamotrigine use were significantly less likely to be depressed (OR = 0.4, 95% CI: 0.2–0.8) compared with those not reporting lamotrigine use.     

Physical illness and lifestyle risk factors in people with their first presentation of psychosis

Background There is an increased prevalence of physical illness and poor lifestyle in patients with chronic schizophrenia. It is unclear whether these are present at the onset of psychosis or develop over the course of illness. We aimed to establish whether patients experiencing their first episode of psychosis have worse physical health and lifestyle than community controls without psychosis. Method Eighty-nine patients with new onset illness were compared to age and sex matched controls for self-reported physical illness and cardiovascular and respiratory risk factors. Results Patients reported more physical health complaints, mainly respiratory, compared with age and gender matched controls (odds ratio 2.85, 95% confidence interval 1.2–6.7). Patients were more likely to be cigarette smokers (1.82, 95% CI 1.0–3.3) and eat a fast food diet (1.04, 95% CI 1.0–1.1), but these differences were accounted for by patients’ unemployment status. Conclusions Some risk factors for physical health problems are present at the onset of psychosis, but these may be explained by unemployment.     

Risk factors for hyperammonemia associated with valproic acid therapy in adult epilepsy patients

Hyperammonemia is one of the side effects of treatment with valproic acid (VPA), but the risk factors and mechanisms involved remain obscure. This study analyzed the risk factors for hyperammonemia associated with VPA therapy in adult epilepsy patients. A retrospective analysis of 2724 Japanese patients (1217 males and 1507 females aged from 16 to 76years) treated with VPA between January 2006 and December 2010 were analyzed. The ammonia level increased markedly in a VPA dose-dependent manner, and was significantly elevated in patients who also used hepatic enzyme inducers such as phenytoin (PHT), phenobarbital (PB), carbamazepine (CBZ), and combinations of these drugs. When a blood ammonia level exceeding 200μg/dl was defined as hyperammonemia, the risk factors for hyperammonemia according to multiple regression analysis were a VPA dose >20mg/kg/day (odds ratio (OR): 4.1; 95% confidence interval (CI): 1.6-10.8) and concomitant use of PHT (OR: 11.0; 95% CI: 3.1-38.7), concomitant PB (OR: 4.3; 95% CI: 1.0-17.9), concomitant CBZ (OR: 2.8; 95% CI: 0.6-11.9), and concomitant topiramate (OR: 2.8; 95% CI: 1.2-6.5). Regimens containing multiple inducers were associated with an increased risk of hyperammonemia. Identification of risk factors for hyperammonemia associated with VPA therapy can help to minimize side effects during its clinical use.     

Acute cervical cord injuries in patients with epilepsy.

Seven cases with acute cervical cord lesions associated with a fit and fall, were found in approximately 500 patients with epilepsy over a period of 7 years. In all patients the epilepsy was refractory to drug therapy and six suffered tonic fits which resulted in falls and frequent head injuries. Notable radiological changes were found in the cervical spine; there was ankylosis in five, hyperostosis in four and the minimum sagittal diameter of the bony canal was less than 11mm in three cases. The findings indicate that repetitive trauma may be a factor in producing bony changes in the cervical spine which put the patient at risk of cervical cord injury, especially when the spinal canal is developmentally narrow.     

Survey of risk factors for osteoporosis and osteoprotective behaviors among patients with epilepsy

The prevalence of risk factors for osteoporosis in persons with epilepsy, patients' awareness of their risk, and their engagement in osteoprotective behaviors were assessed in this study. Two hundred and sixty patients with epilepsy (F = 51.5%, average age = 42) completed a survey tool. Of 106 patients with a dual energy X-ray absorptiometry (DXA) result, 52% had low bone mineral density, and 11% had osteoporosis. The results suggest that the majority of patients with epilepsy do not engage in bone-protective behaviors. Those who have undergone a DXA scan may be more likely to take calcium and vitamin D supplementation compared with those who did not undergo a DXA scan, but they do not engage in other osteoprotective behaviors. Many patients did not accurately report their DXA results, indicating that better patient education is warranted.     

102例癫痫患者预后的危险因素分析

目的:确定预测癫痫预后相关变量,建立模型判断癫痫的预后。方法:回顾性研究102例随访大于24个月的癫痫患者的各种危险因素,用Microsoft Access2003建立数据库,应用单变量分析和多项Logistic回归分析,判断癫痫患者的预后的危险因素,并应用Kaplan-Meier乘积极限估计法估算随访时间点的发作率。结果:在单因素分析中,三组在性别、起病年龄、随访时间、病程、发作类型、全面强直-阵挛发作、睡眠发作、热惊厥史和癫痫家族史无统计学意义,而在病因、发作频率、EEG背景、EEG放电、影像学表现、单、多药治疗、神经系统体征等方面有统计学差异。多项Logistic回归分析结果:根据单因素的分析结果,对病因分级、单药或联合治疗、脑电图慢波、脑电图放电、发作频率的分级、神经系统体征、影像学改变等7个因素进行多项Logistic回归分析,建立回归模型。结论:病因明确、发作频率多、EEG慢波、放电、影像学异常、多药治疗和神经系统有阳性体征的癫痫患者的预后不佳。     

Cervical spinal cord injuries in patients with refractory epilepsy

The incidence of cervical spinal cord injuries (c-SCI) in patients with refractory epilepsy is 30-40 times higher than in the normal population. The injuries occur after seizure-related falls. Risk factors and pitfalls in diagnosis are discussed. Awareness of the risk within this population of developing c-SCI should receive more widely recognition, especially in centres that treat this population.     

Cardiovascular risk factors and homocysteine in epilepsy

Epidemiological studies have found the risk for heart disease and stroke are increased in persons with epilepsy. Anti-epileptic drugs (AEDs) have varying effects on serum lipids and homocysteine-an independent risk factor for coronary disease. The prevalence of cardiovascular risk factors (high cholesterol, hypertension, diabetes, obesity and smoking) and homocysteine were investigated in a multiethnic epilepsy population. Data included demographics, clinical factors, lab assessments and supplementation patterns. Mean age was 45 years (71 males and 94 females)-75 were African American, 27 Latino and 60 Caucasian. Fifty-two percent of participants had two or more cardiovascular risk factors when compared with rates for the general population of 28%. The Framingham risk score (FRS) assessment was also used to compare risk levels. Twenty-nine percent of men and 1% of women had a FRS indicating >5% level of risk, only 7% had a FRS>10%. Cardiovascular screening and primary preventative recommendations based on the American Heart Association and supplementation should be suggested for the adult epilepsy population when appropriate.     

Factors associated with employment in epilepsy patients

ObjectiveThe aim of the study described here was to determine those variables associated with employment in patients followed at a level 4 epilepsy center.MethodA survey was sent to patients seen at the University of Florida Health Science Center/Jacksonville Comprehensive Epilepsy Program.ResultsTwo hundred sixty-two eligible subjects constituted the study population. By univariate analysis, variables that distinguished employed patients included: younger age, Caucasian race, higher education and household income, not receiving disability benefits, currently studying, fewer seizure medications, having no other medical conditions that interfere with work, previous work experience, perceived importance of work for personal and financial reasons, and decreased fears of workplace discrimination. By logistic regression, higher annual family income, perceived importance of work for personal reasons, and decreased fears of workplace discrimination were the only variables independently associated with employment.ConclusionPsychosocial factors such as a high self-perceived importance of work and decreased fears of workplace discrimination are significantly associated with employment in epilepsy patients.