What are the concerns of older adults living with epilepsy?

PURPOSE: The goal of this work was to examine the concerns of living with recurrent seizures as expressed by older adults with epilepsy (OAE). METHODS: Thirty-three community-dwelling adults over the age of 60 (mean age=65, range 60-80) were surveyed as to their concerns living with epilepsy. All patients were being treated for intractable partial epilepsy (mean age at seizure onset=37, range 1-77) and all were receiving antiepileptic drugs (AEDs). Patients were given a blank sheet of paper and asked to list any concerns they had about living with epilepsy. Each patient listed his or her concerns in order of importance. RESULTS: Twenty-eight different areas of concern were listed by the OAE (range 1-6 per patient). Concerns about driving/transportation (64%) and medication side effects (64%) were the most frequently listed concerns. Other concerns listed by >20% of patients included personal safety (39%), AED costs (29%), employment (26%), social embarrassment (21%), and memory loss (21%). Driving/transportation and AED side effects were the two most important concerns. CONCLUSIONS: Quality-of-life issues in OAE appear similar in content to those of younger epilepsy groups. Driving/transportation, role restriction (i.e., grandparenting role), employment, social embarrassment, and safety are major concerns expressed by older adults. However, medication side effects appear more concerning to older adults as compared with earlier studies with younger patients. This study highlights the substantial burden of living with epilepsy in older adults and points to the challenges clinicians have when addressing them.     

Is integrative use of techniques in psychotherapy the exception or the rule? Results of a national survey of doctoral-level practitioners

This study sought to investigate the extent to which therapists endorse techniques outside of their self-identified orientation and which techniques are endorsed across orientations. A survey consisting of 127 techniques from 8 major theories of psychotherapy was administered via U.S. mail to a national random sample of doctoral-level psychotherapy practitioners. The 201 participants endorsed substantial numbers of techniques from outside their respective orientations. Many of these techniques were quite different from those of the core theories of the respective orientations. Further examining when and why experienced practitioners switch to techniques outside their primary orientation may help reveal where certain techniques fall short and where others excel, indicating a need for further research that taps the collective experience of practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Does a sedative dose of chloral hydrate modify the EEG of children with epilepsy?

Chloral hydrate (CH) is used to sedate children unable to cooperate during investigations such as EEG requiring the patient to be still. It is not known if CH or its metabolites modify the EEG and our aim was to answer this question. Recordings of the EEG before, during and after rectal administration of CH (50–77 mg/kg) in 13 children aged 1.5–13.5 years with severe epilepsy and additional neurological impairments were made. All children had frequent spike-wave activity before CH. In 9 children CH had no effect on the EEG. In 3 children there was a significant reduction in epileptic activity after 20–50 min and in one a significant increase. Cardiovascular parameters were stable throughout. At sedative doses, CH can generally be used before an EEG recording without loss of information but in 4 out of 13 children there were changes which could alter interpretation.     

What are the predictors of major depression in adult patients with epilepsy?

Epilepsy is not only a chronic neurological disorder but also a condition associated with other comorbidities. The purpose of this study was to determine the prevalence of major depression in a cohort of adult patients with epilepsy (PWEs) living in north China, and investigate the predictors of major depression in PWEs. A total of 215 consecutive cases were enrolled and divided into two groups: PWEs with major depression and PWEs without major depression. Patients were assessed for demographic characteristics, epilepsy details, and social status. A total of 65 of 215 (30.23%) PWEs exhibited comorbid major depression. A binary logistic regression model revealed the strong predictor variables of major depression to be drug responsiveness (odds ratio [OR]=0.23; p=0<0.01; 95% CI [0.13–0.39]), presence of chronic medical illnesses (OR=0.19; p=0.015<0.05; 95% CI [0.05–0.72]), and employment status (OR=0.42; p=0.015<0.05; 95% CI [0.21–0.84]).     

Disease- and treatment-related effects on the pituitary–gonadal functional axis: a study in men with epilepsy

The consideration of the patient’s gender has become an established practice in the choice of antiepileptic drugs (AEDs) for the treatment of epilepsy. This study was undertaken to confirm that temporal lobe epilepsy and the use of hepatic enzyme-inducing AEDs, have a negative effect on sex hormones in men. We calculated the testosterone (T)/luteinizing hormone (LH) ratio to reflect the effects of epilepsy or its treatment on the most important androgen and its pituitary control hormone. Of 324 men with focal epilepsy identified (untreated or on AED monotherapy), 201 were eligible for inclusion (mean age 37.5 years¸ mean duration of epilepsy 14.7 years). A total of 105 men served as healthy controls (mean age 33.9 years). Patients with temporal lobe epilepsy were more likely to show abnormal T/LH ratios than patients with extratemporal epilepsy (p < 0.01). Patients receiving AEDs with marked hepatic enzyme-inducing effects were more likely to have low T/LH ratios than patients taking nonenzyme-inducing AEDs or healthy controls (p < 0.01). Focus localization and AED choice affect male sex hormones. Findings raise some concerns about the effect of enzyme-inducing AEDs on sexual endocrine functions.     

How do individuals sleep around the world? Results from a single-day survey in ten countries

BACKGROUND AND PURPOSE: To describe between-country differences in both the prevalence and type of sleep disorders seen across the globe, and to provide information on how impaired sleep impacts daytime functioning. PATIENTS AND METHODS: The study is a large-scale, global cross-sectional survey conducted on International Sleep Well Day (March 21), 2002. A standardized questionnaire was used in 10 countries under the guidance of local survey managers. In addition, the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS) were completed. Subjects included in the study were adults from 10 countries representing different continents with clear variations in lifestyle. RESULTS: The total number of questionnaires collected was 35,327. Overall, 24% of subjects reported that they did not sleep well. According to self-assessments using the AIS, 31.6% of subjects had 'insomnia', while another 17.5% could be considered as having 'sub-threshold insomnia'. According to ESS scores, 11.6% of subjects were found to be 'very sleepy' or 'dangerously sleepy' during the day. CONCLUSIONS: Although there seem to be important global variations in the prevalence of insomnia, its symptoms and their management, about one in four individuals do not think they sleep well. Moreover, self-reported sleep problems could be underestimated in the general population. Overall, there is a need for increased awareness of the importance of disturbed sleep and the improved detection and management of sleep disorders.     

Health-related quality of life of children with epilepsy in Hong Kong: How does it compare with that of youth with epilepsy in Canada?

OBJECTIVE: The primary aim of our study was to compare the health-related quality of life (HRQL) of children with epilepsy in Hong Kong with that of children with epilepsy in Canada, and to explore possible factors affecting these findings. A second interest was to determine agreement between proxy reports and self-ratings among children with epilepsy in Hong Kong, compare these with findings in Canada, and identify factors that influence the concordance. METHODS: Child self-report and parent-proxy questionnaires on an epilepsy-specific HRQL measure, appropriately translated and validated in Chinese, were administered to 266 Hong Kong children and their parents. An unpaired t test was used to compare the scores with published results from 381 Canadian children and their parents, who used the original English version of the measure. Demographic characteristics of the two groups were compared using t tests, chi2 tests, and Fisher's exact tests. Agreement between parents' and children's scores was evaluated with intraclass correlation coefficients (ICCs) and standardized response means (SRMs). The total HRQL score differences between parents and children in Hong Kong were compared with those in Canada using an unpaired t test. Factors that might affect the parent-child score difference were studied using Pearson correlation analysis, chi2 test, and analysis of variance. Factors studied included: sex, current age, age at diagnosis, duration of epilepsy, number of antiepileptic drugs used, type of seizure, seizure severity, cognition of the child, the type of school attended, presence of neurological problems, presence of behavioral problems, recent health care usage, education and employment status of both parents, housing status of the family, and relationship of the proxy respondent to the child. RESULTS: (1) In contrast to the Canadian sample, Hong Kong children with epilepsy were older (P<0.01), had a longer duration of epilepsy (P<0.01) and less severe seizures (P<0.01), and were more likely to attend normal schools (P<0.01). Children in Hong Kong reported more interpersonal/social difficulties (P<0.01), more worries (P<0.01), and more secrecy about their epilepsy (P<0.01). Parents in Hong Kong believed that their children perceived more worries (P<0.01) and were more secretive about their epilepsy (P<0.01). (2) Moderate to good agreement between parent-proxy response scores and child self-report scores was demonstrated (ICC=0.50-0.69, SRM=0.19-0.33). The total HRQL score differences between parent and child in Hong Kong were not different from those in Canada. None of the factors studied were related to the parent-child score difference. CONCLUSIONS: Youth with epilepsy in Hong Kong and their parents reported poorer quality of life than children with epilepsy in Canada. Further studies are necessary to identify the determinants of HRQL in children with epilepsy in different cultures. Acceptable agreement between the two ratings suggests that proxy reports can be used when child self-reports cannot be obtained.     

What are patients and their families told about the diagnosis of dementia? Results of a family survey

BACKGROUND: Controversy exists as to whether dementia patients should be told their diagnosis and prognosis. OBJECTIVE: This study examined the experience of patients and families when a diagnosis of dementia is given. METHOD: Fifty-seven family members from community dementia support groups answered a questionnaire regarding the diagnosis of dementia in a family member. RESULTS: Family members were significantly more likely to have been told the diagnosis and symptoms to expect in dementia than patients themselves. Half of the families felt they were not given enough information regarding dementia. Interestingly, the majority of family members believed patients should be told their diagnosis and prognosis yet about half had reported that informed patients had reacted poorly to being told their diagnosis and only about a third felt it was helpful to the patient. CONCLUSION: The results suggest physicians should better involve patients and their families in disclosing diagnoses and information regarding dementia. The results also suggest the current AMA guidelines to inform patients their diagnosis of dementia are inadequate to address the clinical complexities of this issue.     

Whose life am i living? Relatives living in the shadow of depression

BACKGROUND: Families living with mental illness experience added burden and need information and support. AIM: This aim of this study was to explore the experiences of families living close to a depressed individual. METHODS: Eighteen persons were interviewed individually or in focus groups. Data was analysed using a grounded theory-inspired methodology. RESULTS: Most participants expressed a feeling of not living their own life, struggling to balance relationships, adapting to and re-evaluating their life circumstances, and struggling to voice their ill relatives' and their own needs. CONCLUSIONS: More can be done to help and sustain hope in the relatives of persons with depression.     

Does angiogenesis play a role in the establishment of mesial temporal lobe epilepsy?

Mesial temporal lobe epilepsy (MTLE) is a focal epileptic disorder that is frequently associated with hippocampal sclerosis. This study investigated whether blocking angiogenesis prevents the development of seizures and hippocampal atrophy in the pilocarpine rat model of MTLE. To block angiogenesis, a subset of animals were given sunitinib orally. Continuous video recordings were performed to identify seizures. Brains were then extracted and sectioned, and hippocampal surfaces and angiogenesis were assessed. After a latent period of 6.6 ± 2.6 days, the sham-treated pilocarpine rats presented convulsive seizures, while the pilocarpine rats treated with sunitinib did not develop seizures. Sham-treated pilocarpine rats but not sunitinib-treated pilocarpine rats had significantly smaller hippocampi. Endothelial cell counts in sham-treated pilocarpine rats were significantly greater than in controls and sunitinib-treated pilocarpine rats. Blocking angiogenesis immediately following the initial insult in this animal model prevented thus angiogenesis and hippocampal atrophy and averted the development of clinical seizures.     

Hyperhomocysteinemia in patients with epilepsy: Does it play a role in the pathogenesis of brain atrophy? A preliminary report

Purpose:   Brain atrophy (BA) is observed in 20–50% of patients with epilepsy. Hyper-total-homocysteinemia (hyper-tHcy), which occurs in 10–40% of patients, is considered to be a risk factor for cardiovascular diseases and BA. The present study was aimed at investigating the possible association of hyper-tHcy with BA in a population of patients with epilepsy.
Methods:   Fifty-eight patients (33 M/25 F, 43.5 ± 13.1 years of age) chronically treated with antiepileptic drugs (AEDs) and 60 controls matched for age and sex were enrolled. All participants underwent determination of plasma tHcy, folate, vitamin B₁₂, and C677T methylene-tetrahydrofolate-reductase (MTHFR) polymorphism genotyping, and brain magnetic resonance imaging (MRI).
Results:   Patients exhibited significantly higher tHcy and lower folate levels than controls; hyper-tHcy was significantly associated with the variables group (patients vs. controls), MTHFR genotype, and their interaction terms. BA was observed in 30.1% of patients and was significantly associated with hyper-tHcy (β = 0.45, p = 0.003) and polytherapy (β = 0.31, p < 0.001).
Discussion:   Our investigation suggests that hyper-tHcy plays a role in the development of BA in patients with epilepsy. Although the real origin of this phenomenon is not yet fully elucidated, experimental data support the hypothesis of a link of the neuronal Hcy-mediated damage with oxidative stress and excitotoxicity.     

Trends in reporting injury as a cause of death among people with epilepsy in the U.S., 1981–2010

PurposeTo examine trends in reporting injury as a cause of death among people with epilepsy in the U.S. during the past three decades.MethodWe analyzed the U.S. multiple causes of death data from death certificates in 1981–2010 to compare rate and odds ratios (OR) of reporting injury as cause of death among cases with vs. without mention of epilepsy across years.ResultsThe trends in reporting epilepsy with and without injury were similar in most age groups but were inconsistent in most external causes of injury. The OR of reporting injury was 1.02 (95% confidence intervals (CI) 0.97–1.07) in 1981–1985 and decreased to 0.52 (95% CI 0.48–0.55) in 2006–2010. The decline in OR was prominent among people aged 15–24 followed by people aged 25–44. For the five external causes of injury, the OR of suffocation and drowning were 6.32 (95% CI 5.91–6.75) and 5.64 (95% CI 5.16–6.16) in 1981–1985 and decreased to 3.03 (95% CI 2.74–3.35) and 2.56 (95% CI 2.18–3.00) in 2006–2010. The OR for poisoning and traffic crashes were 0.70 (95% CI 0.57–0.85) and 0.08 (95% CI 0.07–0.09) in 1981–1985 and 0.21 (95% CI 0.18–0.25) and 0.06 (95% CI 0.05–0.08) in 2006–2010.ConclusionThe risk of fatal injury among people with epilepsy decreased drastically during the past three decades in most age groups and for most external causes of injury except falls. People with epilepsy had lower risks of dying from injury due to poisoning or traffic crashes, had higher risks of dying from suffocation and drowning.