传统抗癫疒间药物与托吡酯对成年癫疒间患者生活质量影响的对比研究

目的 探讨传统抗癫癎药物(AEDs)与托吡酯(TPM)对成年癫癎患者生活质量(QOL)的影响。方法 102例临床确诊的成年癫癎患者随机分为AEDs组和TPM组,井用QOL IE-30表对102例癫癎患者和62名正常人(对照组)进行评定。结果 AEDs组较对照组QOL明显降低(P<0.05),表现惧怕发作,对日常生活不满意,情绪差,精力不足,认知功能下降,对长期服用抗癫癎药物的顾虑较多,社交、工作受限等;而TPM组的QOL虽然低于对照组(P<0.05),但在前5项的评分中明显高于AEDs组(P<0.05)。TPM组的发作频率明显低于AEDs组(P<0.05)。发作频率对癫癎患者QOL的影响较大,癫癎发作越频繁,QOL越差。结论 成年癫癎患者的QOL较正常人显著降低,TPM能提高癫癎患者的QOL,其改善QOL的作用主要是通过控制发作实现的。因此,合适的药物控制癎性发作是提高癫癎患者QOL的关键。     

A comparison of self-reported quality of life between patients with epilepsy and neurocardiogenic syncope

Epilepsy and neurocardiogenic syncope share a final common pathway of loss of consciousness and consequent social disruption. We compared 52 patients with syncope, 96 with epilepsy and 100 controls. Epilepsy and syncope patients expressed significantly higher levels of anxiety and depression and reported significantly less good quality of life (QoL) compared with controls. There were no significant differences on any of the QoL parameters measured between the syncope and epilepsy patients. These findings suggest the main contributor to poor QoL in epilepsy may be the unpredictable loss of control that is the hallmark of the condition.     

Validity of three measures of health-related quality of life in children with intractable epilepsy

PURPOSE: Validity studies on health-related quality of life (HRQOL) scales for pediatric epilepsy are few, and cross-validation with other samples has not been reported. This study was designed to assess the validity of three parent-rated measures of HRQOL in pediatric epilepsy: (a) the Impact of Childhood Illness Scale (ICI), (b) the Impact of Child Neurologic Handicap Scale (ICNH), and (c) the Hague Restrictions in Epilepsy Scale (HARCES). METHODS: Retrospective data were examined for 44 children with intractable epilepsy. Validity was assessed by evaluating differences across epilepsy severity groups as well as correlations between HRQOL scales and neurologic variables (seizure severity, epilepsy duration, current/prior antiepileptic medications) and psychosocial measures (emotional functioning, IQ, social skills, adaptive behavior). Scale overlap with a global QOL rating also was assessed. RESULTS: The HRQOL measures were moderately to highly intercorrelated. The scales differed in terms of their associations with criterion measures. The HARCES was related to the highest number of neurologic variables and the ICNH to the fewest. All three scales were related to psychosocial functioning and to global quality of life. CONCLUSIONS: The results of this study suggest that the three measures are likely adequate measures of HRQOL for use in intractable childhood epilepsy. The measures were highly intercorrelated, and they were all broadly related to criterion measures reflecting specific domains of HRQOL as well as global QOL. Some differences between scales emerged, however, that suggest care in choosing HRQOL instruments for children with epilepsy.     

颞叶癫痫患者生活质量及其影响因素的研究

目的观察颞叶癫痫患者生活质量的状况,并探讨社会人口学、临床发作以及焦虑、抑郁等因素对患者生活质量的影响。方法对93例颞叶癫痫患者和100名健康对照者进行生活质量量表-31(QOL-31)、Zung氏抑郁自评量表(SDS)和Zung氏抑郁自评量表(SAS)测定。结果颞叶癫痫患者生活质量各项得分均明显低于健康对照组(P<0.001),焦虑和抑郁自评量表得分均明显高于健康对照组(P<0.001)。多元逐步回归分析显示,影响生活质量的主要因素为抑郁、发作严重程度、焦虑和病程。结论颞叶癫痫患者生活质量存在不同程度下降。发现和治疗颞叶癫痫患者的抑郁、焦虑等精神心理问题以及选择合理治疗方法、控制癫痫发作是提高生活质量、改善预后的重要前提。     

拉莫三嗪对癫(癎)患者认知功能与生活质量的影响

目的 评价拉莫三嗪对癫(癎)患者认知功能以及生活质量的影响.方法 对91例新诊断的癫(癎)患者给予拉莫三嗪治疗,并在用药前及用药16周后进行认知功能评定及生活质量调查.认知功能评定工具包括听觉词语测验、逻辑记忆测验、数字符号转换测验、Stroop字色干扰测验、连线测验、言语流畅性测验、韦氏积木测验、数字广度测验及Boston命名测验;生活质量调查采用患者生活质量评定量表-31(QOLIE-31).结果 癫(癎)患者应用拉莫三嗪治疗16周后与用药前比较,各项得分均有提高,其中以即刻与延迟词语记忆、情景记忆、执行功能、空间知觉能力以及言语命名功能方面改善显著.生活质量方面,QOLIE-31量表的7个测评方面及1个总体健康评价中,6项分值在用药后较用药前有所提高,其中"对癫(癎)的担心"(38.81±16.06,16周后45.68±15.18,P＜0.01)、"总体生活质量"(59.12±13.50,16周后64.99±13.33,P＜0.01)、"社会功能"(64.59±25.14,16周后69.41±22.70,P＜0.05)以及"总体自身健康评价"(71.18±13.73,16周后76.75±11.30,P＜0.01)4项的得分差异有统计学意义.结论 拉莫三嗪单药治疗新诊断癫(癎)患者可在短期内改善其认知功能,并提高生活质量.     

随访系统对提高癫痫患者生活质量的作用

目的 探讨建立随访系统对提高癫痫患者生活质量的作用.方法 将98例癫痫患者随机分为观察组48例和对照组50例.对照组实施常规出院宣教,观察组在此基础上利用随访系统由护士协助医生进行有计划、定期电话随访式健康教育,干预6个月、1 a后分别比较2组生活质量及疾病复发率.结果 观察组生活质量明显优于对照组(P＜0.05),疾病复发率显著低于对照组(P＜0.05).结论 随访系统的建立可增强癫痫患者的自我管理能力,干预后生活质量显著提高,降低疾病复发率.     

Quality of life in young Italian patients with epilepsy

Abstract The objective was to evaluate the quality of life of young Italian patients with epilepsy and to investigate the influence of epilepsy medical variables on patients quality of life. The settings were the Department of Paediatrics, University of Padua; Childrens Hospital Giovanni XXIII, Bari; and three schools of South Italy. A sample of 285 subjects was selected: 140 subjects affected by idiopathic and cryptogenic epilepsy (classified according to the International League Against Epilepsy criteria) and 145 control subjects. Data derived from the comparison between the two groups throughout Epilepsy and children questionnaire confirmed the negative epilepsy impact on the young patients quality of life: in fact they scored significantly lower on psychological and social domains (p0.05) than the control group. The quality of life in children with epilepsy is significantly compromised. The questionnaire used in this study is a valid and reliable self-evaluation instrument that can improve clinical research on the quality of life in epilepsy.     

Validation of the quality of life in childhood epilepsy questionnaire in American epilepsy patients

The aim of this study was to adapt the Australian Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) and determine its psychometric properties in a North American population. Participants were North American families with children diagnosed with epilepsy. Parents were asked to complete the American QOLCE (USQOLCE) and the Child Health Questionnaire (CHQ). Seventy-one families completed the USQOLCE. The internal consistency reliability of the subscales was good. USQOLCE subscales correlated highly with theoretically similar subscales contained in the CHQ. Theoretically dissimilar subscales on the two instruments did not correlate as well. USQOLCE correlated significantly with a parental rating of seizure severity and an independent measure of degree of postoperative seizure control. This study demonstrated that the USQOLCE is suitable for a North American population with evidence of its reliability and validity including its sensitivity to seizure burden.     

Determinants of quality of life in epilepsy

Although depression is associated with diminished quality of life (QOL) in epilepsy patients, the relative contributions of epilepsy-specific concerns, as well as clinical and cognitive variables of QOL, have not been simultaneously investigated. A comprehensive neuropsychological test battery including the Beck Depression Inventory (BDI), Epilepsy Foundation of America's (EFA) Concerns Index, MMPI-2, QOLIE-89, WAIS-III, and Selective Reminding was administered to 115 epilepsy surgery candidates with normal Full Scale IQs. Linear regression analyses were performed to identify significant predictor combinations of QOLIE-89 total score. Regression analysis demonstrated that depressive symptomatology, whether reflected by the BDI (R2=0.45) or Depression scale of the MMPI-2 (R2=0.36), was a robust individual QOL predictor. Seizure Worry from the EFA Concerns Index was nearly as effective as the BDI in predicting QOLIE-89 (R2=0.42). When the BDI and EFA Concerns Index were combined into the same regression, both factors continued to contribute significantly to the QOLIE-89 total score, with both variables accounting for 61% of the variance. Although patients who developed their seizures at an older age had poorer QOL and patients with higher educational levels reported higher QOL, neither factor was related to QOL after accounting for the effects of psychological variables and epilepsy-related concerns. Although quality of life has multiple determinants, symptoms of depression and seizure worry are the most important factors affecting QOL in patients with intractable epilepsy.     

Psychopharmacological treatment status in outpatients with bipolar disorder: a clinical survey in Germany

Objective

The objective of this epidemiological study was to evaluate the current treatment status as well as the acceptance of medication and satisfaction with life in outpatients with bipolar disorder in Germany.

Methods

Data for this cross-sectional epidemiologic survey was collected between February 15th, 2006 and May 31st, 2006. Three hundreds six bipolar euthymic outpatients under routine treatment conditions were included in the study. Forty one practicing psychiatrists used a clinical interview to evaluate the current treatment status, acceptance of current medication, and current life satisfaction.

Results

The majority of patients suffered from "pure" bipolar-II-disorder (50.6%), followed by 23.0% with "pure" bipolar-I-disorder. Apart from these patients, 12.9% of all participants had a history of mixed episodes and 5.6% a history of rapid cycling. Mean duration of bipolar disorder was 10.6 years. The majority of patients (54.3%) received psychopharmacological monotherapy. Combination therapy was administered in 45.9% of the patients, 39.3% receiving two agents, and 6.6% three agents. Antidepressants (64.1%) were the most common combination medications. Monotherapy was used preferably in bipolar-I- (62.7%) and bipolar-II-disorders (56.2%), combination therapy predominantly in patients with a history of mixed episodes (57.7%) and rapid cycling (55.0%). Half of the patients (49.2%) were able to hold an occupation. 84.2% of all patients were satisfied with their medication. Overall, patients evaluated their life satisfaction between "good" and "satisfactory" (2.69 according to German school grades where 1 is the highest and 6 the lowest mark). Patients receiving lithium, valproate or antidepressants as monotherapy rated above the mean, patients with combination therapy, carbamazepine monotherapy or medications summarized as "others" rated below the mean.

Conclusion

Most of the German outpatients received a pharmacotherapy that is recommended in the guidelines of bipolar disorder. The use of (atypical) antipsychotics was low. Conversely, the incidence of treatment with tricyclic antidepressants (not guideline compatible), was observed to be relatively high. Irrespective of their medication, in Germany patients with bipolar disorder show a high acceptance of their pharmacotherapy, and rate their life satisfaction as high. Nonetheless, half of the evaluated patients were not able to pursue a profession. Besides the disease age, gender and family life e.g., child care may also play a confounding role regarding the unemployment statistics.     

Seizure reduction and quality of life improvements in people with epilepsy

PURPOSE: Previous research suggests that seizure freedom may be necessary to improve health-related quality of life (HRQOL) for epilepsy surgery patients, but little is known regarding the seizure-frequency reduction needed to improve HRQOL among medically treated individuals. METHODS: With data from 134 adults with refractory complex partial seizures participating in a randomized controlled antiepileptic drug (AED) trial, we compared the change in HRQOL across groups having different levels of change in seizure frequency: 100%, 75-99%, 50-74% reduction, and 0-50% increase or decrease. Changes over time within each seizure-reduction group also were assessed. HRQOL was measured by the QOLIE-31, QOLIE-89, and SF-36. RESULTS: Subjects who became seizure free reported significantly more positive change than those who did not on the QOLIE-31 and QOLIE-89 overall scores, the QOLIE-89 mental health, physical health, and epilepsy-targeted composites, as well as the SF-36 mental health summary score. Changes over time in overall QOLIE-31 and QOLIE-89 scores were significantly more positive for subjects who achieved seizure freedom (i.e., 100% reduction in seizure frequency) than for those who did not. No significant change in QOLIE-31 and QOLIE-89 overall scores was observed for subjects who did not achieve seizure freedom. CONCLUSIONS: In this study, HRQOL improvement occurred primarily among patients who achieved complete seizure freedom. Many AED trials use a 50% seizure-frequency reduction criterion as a trial end point, but measurable impacts of this degree of reduction in seizure frequency on HRQOL in this sample were not observed. These results further support striving for seizure freedom as an epilepsy care goal.     

成年癫痫患者生活质量的研究

目的　评价成年癫痫患者的生活质量。方法　对符合入选标准的 33例成年癫痫患者和正常对照者 17名 ,进行癫痫患者生活质量量表 31(QOLIE 31)、Zung氏抑郁自评表 (SDS)的评估。结果　SDS评分水平与QOL的多个方面呈独立负相关 ,病程是总体健康水平、药物影响的独立危险因素。全身强直 阵挛发作 (GTC ,17例 )、复杂部分性发作 (CPS ,16例 )两组患者在药物影响 (分别为 6 1 0± 2 3 8和 5 6 6± 19 4,对照组为 10 0± 0 0 )、对发作的担忧两方面均与对照组有显著性差异 (P <0 .0 0 1)。GTC组从事脑力劳动的人数大大低于学历背景相似的对照组 (P =0 0 1) ,而CPS组从事脑力劳动的人数与对照组相比差异无显著性意义 (P =0 .479) ,GTC组与CPS组相比未见显著性差异 (P =0 .0 97)。男性癫痫患者在婚育方面受到的影响有大于女性患者的趋势。结论　成年癫痫患者生活质量低于健康对照组。     

强迫障碍对患者生活质量影响的研究

目的探讨强迫障碍对患者生活质量的影响。方法采用TDL生活质量量表评估强迫障碍患者的生活质量。结果强迫障碍组的身体方面、心理方面、社会方面、尽职的能力、自我健康意识及TDL量表总分均显著地低于对照组(P<0.05)。结论强迫障碍对患者的生活质量影响很大,应积极治疗。     

癫癎患者生活质量的研究

目的探讨成年癫癎患者生活质量状况及其影响因素.方法实验组86例癫癎患者,对照组59名健康自愿受试者.用世界卫生组织生存质量量表中文版简表(Q0 L-BREF)、癫癎患者生活质量量表(QOLIE-31)评定生活质量;用症状自评量表评价心境健康;分析各种影响因素的作用.结果实验组生活质量在心理领域得分比对照组低(P＜0.05);除精力/疲乏领域外的各领域均有50%以上实验组QOLIE-31得分低于平均水平;实验组的抑郁、焦虑分均比对照组明显增高(P＜0.0001);影响QOLIE总分的三个因素按作用大小依次是抑郁、焦虑和用药种数.结论癫癎患者生活质量下降,心境健康恶化;对总体QOLIE影响最大的因素是抑郁、焦虑和用药种数.     

成年难治性癫痫患者立体定向术后生活质量的调查分析

目的调查分析立体定向手术治疗对成年难治性癫痫患者生活质量的影响。方法对92例无明确致痫灶的成年难治性癫痫患者进行立体定向手术治疗,采用症状自评量表(SCL-90)、癫痫患者生活质量量表-31(QOLIE-31)在手术前及手术后半年、1年、2年、3年、4年、5年对患者进行连续评估。结果尽管部分患者术后癫痫症状不能完全控制,但患者总的生活质量在手术后各阶段均较术前明显提高。手术效果EngelⅠ级患者术后各时间段的生活质量优于Ⅱ~Ⅳ级患者的生活质量。术前具有明显精神症状患者术后各时间段的生活质量与术前无精神症状患者的术后生活质量比较无明显差异。结论对于经术前综合评估不能确定致痫灶,特别是伴有明显精神症状的难治性癫痫患者,立体定向手术治疗是一种有效的治疗手段,可显著改善这部分患者的生活质量。     

癫癎患者生活质量及其影响因素的研究

目的研究癫痫间患者的生活质量及其影响因素。方法采用癫痫间患者生活质量量表-31(QO-LIE-31)对56例确诊的癫痫间患者和46例对照者进行评价。结果癫痫间组患者QOL各项得分均显著低于对照组(P<0.05);全身性强直-阵挛发作(GTCS)和复杂部分性发作(CPS)患者QOL各项得分无显著差异(P>0.05);伴有抑郁的癫痫间患者在对发作的担忧、情绪健康、精力/疲乏和总体健康水平方面低于不伴有抑郁的癫痫间患者(P<0.05);服用1种抗癫痫间药物(AED)的患者与服用1种以上的患者比较,在对发作的担忧、综合生活质量、情绪方面、药物的影响以及总体健康水平方面得分显著降低(P<0.05)。结论癫痫间患者生活质量显著降低,抑郁和服用多种AED对生活质量影响较大。     

Self-reported psychopathological symptoms and quality of life in outpatients with bipolar disorder

PURPOSE. Patients with bipolar disorder in a euthymic mood state can suffer from subsyndromal or residual symptoms of depression or hypomania. This study was undertaken to gain insight into the broader spectrum of psychopathological symptoms and quality of life. DESIGN AND METHODS. Participants (n = 157) completed the Symptoms Checklist‐90, the World Health Organization Quality of Life Assessment Instrument–Bref, and a questionnaire addressing demographic and clinical characteristics. FINDINGS. Outpatients with bipolar disorder reported fewer symptoms of psychopathology than psychiatric outpatients in general, but relative to the general population, a significantly lower quality of life was reported. The number of symptoms showed consistently negative correlations with the quality of life. PRACTICE IMPLICATIONS. The results of this study urge nurses to not settle for treatment response in terms of reduced manic or depressive episodes, but instead to strive for full remission of all symptoms.     

成年癫痫病人的生活质量及其影响因素

目的　研究癫痫病人的生活质量及其影响因素 ,为进一步治疗提供线索 ,以提高病人生活质量。方法　用癫痫病人生活质量量表 30 (QOLIE 30 )对 10 6例临床确诊的成人癫痫病人和 6 4名对照进行评定。结果　癫痫组较对照组生活质量明显降低 [QOL得分分别为 5 4± 16和 77± 15 ],表现在惧怕发作 ,对日常生活不满意 ,情绪差 ,精力不足 ,认知功能下降 ,对长期服用抗癫痫药物的顾虑较多 ,社交、工作受限等。不同性别、不同病程、不同用药数量、不同发作频率病人的生活质量比较 ,用药和发作频率对生活质量影响较大 ,QOL与用药数量呈负相关 ,与发作频率负相关。结论　癫痫病人生活质量明显降低 ,用药和发作频率对生活质量影响较大 ,合适的药物控制癫痫发作是提高癫痫病人生活质量的关键。     

Manic episode in epilepsy and bipolar I disorder: a comparative analysis of 13 patients

PURPOSE: To determine whether the manic episode of patients with epilepsy has different characteristics from manic episode of patients with bipolar disorder. METHODS: Interictal manic episodes in patients with epilepsy (epilepsy group) were compared with mood disorders in patients with bipolar I disorder (bipolar group), as defined by the DSM-IV. There were 13 patients (five women and eight men) in each group. RESULTS: Five epilepsy patients had relatives with epilepsy and/or convulsions, and four bipolar patients had relatives with mood disorders. In the epilepsy group, two had substance-related or organic factors associated with the episodes besides epilepsy, and two exhibited a postictal manic state that had the same symptoms as those of their interictal manic episodes. Ten patients of the epilepsy group had dependent-childish behavior. The epilepsy group had fewer severe mood episodes than the bipolar group. Ten epilepsy patients had fluctuating mood disturbances, and eight had rapid cycling of mood episodes. The epileptogenic zone was in the frontal and/or temporal lobes of eight patients and in multiple lobes of two others; it could not be localized in the three remaining patients. CONCLUSIONS: The clinical features of the interictal manic episodes in the epilepsy group were different from those in the bipolar group. The manic episodes of the epilepsy group appeared heterogeneous in their causal factors. An epileptogenic zone in the frontal and temporal lobes seems to play an important role in the mood episodes of the majority of patients with epilepsy.     

传统抗癫痫药物和妥泰对成年癫痫患者生活质量的影响

目的 评价传统抗癫痫药物和妥泰对成年癫痫患者生活质量的影响。方法 102例临床新确诊的成年癫痫患者被随机分为两组：一组予以传统抗癫痫药物单药系统治疗(AEDs组)，另一组予以妥泰单药治疗(TPM组)。1个月后比较两组的发作频率和不良反应。并用QOLIE-30表对这102例癫痫患者进行生活质量评定。结果 TPM组的发作频率和不良反应均明显低于AEDs组，而生活质量总分明显高于AEDs组，尤其在前五项的评分中更加明显。结论 TPM能提高癫痫患者的生活质量，其改善生活质量的作用主要是通过控制发作和减轻不良反应实现的。