Health status of people with epilepsy compared with a general reference population

PURPOSE: To study the impact of epilepsy in a representative sample of people with epilepsy and compare with a normal reference population. METHODS: We collected clinical and demographic data and information on health status by using the Short Form 36 (SF-36) questionnaire in two populations: (a) 397 patients with confirmed epilepsy attending a county hospital during a 7-year period, and (b) 1,663 patients from a random sample representative of the entire national population. RESULTS: The respondents with epilepsy had well-regulated disease and showed the characteristics of a community sample: 70% had had no seizures during the last year, and 80% used antiepileptic drugs (AEDs). On six of eight SF-36 scales, patients with epilepsy had lower scores than the normal reference population, and they were less likely to be married, employed, or a full-time student. Seizure-free patients with epilepsy had scores close to those of the normal reference population, with higher scores on the social functioning and mental health scales and lower on the role--emotional scale. There were no differences in health status scores between seizure-free patients using and not using AEDs. CONCLUSIONS: Our results confirm that patients with well-regulated epilepsy have a health status at the level of a general reference population.     

Health-related quality of life of people with epilepsy compared with a general reference population: a Tunisian study

PURPOSE: The goal of the study was to assess the health-related quality of life (HRQOL) of persons with epilepsy (PWE) by using the short form survey 36 (SF-36), to compare it with that of a control group and to detect factors influencing it. METHODS: We collected clinical and demographic data and information on health status by using the Arabic translation of the SF-36 questionnaire from two groups: (a) 120 PWE consulting our outpatient clinic during a period of 4 months, and (b) 110 Tunisian citizens, representative of the Tunisian general population, as a control group. RESULTS: The mean age of PWE group was 32.74 years, and 45.5% were men. Idiopathic generalized epilepsies were observed in 44.5% of cases, and symptomatic partial epilepsies, in 30%. The most commonly prescribed drug was sodium valproate (VPA). For the SF-36, PWE had lower scores than the control group for only three subscales: general health perception, mental health, and social functioning. Seizure frequency, time since last seizure, and the antiepileptic drug (AED) side effects were the most important variables influencing the HRQOL among PWE. Seizure-free adults have HRQOL levels comparable to those of the control group. Sociodemographic variables had no influence on the SF-36 subscales. CONCLUSIONS: HRQOL is impaired in Tunisian PWE. The influencing factors identified in this study differ from the previously published data. Several possible reasons such as family support and cultural and religious beliefs are proposed to explain these cross-cultural differences. A larger study should be conducted to verify such findings.     

Lower life satisfaction in physicians compared with a general population sample

Background  There is a strong need for longitudinal and representative studies that focus on doctors’ well-being. Methods  We conducted a longitudinal and nationwide cohort study (N = 631) of graduating medical students (T1), followed up in their first (T2), fourth (T3) and ninth (T4) postgraduate years. Response rates varied from 62 to 83%; the longitudinal response rate was 41%. We used comparison samples from a general population survey. Predictors of life satisfaction among the doctors were tested by linear regressions and repeated measures statistics. Results  Doctors of both genders had significantly lower levels of life satisfaction than those in the comparison samples. Life satisfaction was lowest at T1, improved at T2, and stayed at the same level thereafter. Adjusted predictors of life satisfaction at T4 were lower age (P = 0.03), low level of neuroticism personality trait (P = 0.02), being married/cohabiting (P < 0.001), perceived social support (P < 0.001), lower work stress (P = 0.002), negative life events (P = 0.002), and frequency of physical training (P = 0.04). Only one-fifth of the total explained variance (R ² = 0.34) was due to personality traits, whereas half was explained by married/cohabitant status and perceived social support. Being married/cohabiting, social support and physical training remained significant when mental distress (anxiety and depressive symptoms) was included in an additional multivariate model (R ² = 0.49). Neuroticism trait (P < 0.001) was a significant predictor in the repeated measures model, but the increase in life satisfaction from T1 to T2 was predicted by lower levels of conscientiousness trait (P = 0.009). Conclusions  Norwegian doctors were less satisfied than an educationally age-matched group of the general population. Concurrent situational factors and stress, such as social support and mental distress were of major importance. However, personality clearly predicted life satisfaction over the years.     

Mortality in adult patients with epilepsy in Taiwan.

To investigate mortality in adult patients with epilepsy in Taiwan, a total of 263 patients with epilepsy aged > or = 17 years, referred to the outpatient epilepsy clinic between 1 Jan and 31 December 1991, were prospectively enrolled and followed up until 31 December 2000. A total of 32 deaths were reported. Overall case-fatality rate was 12.2%. The age-adjusted standard mortality ratio (SMR) was calculated to compare the risk of death in patients with epilepsy to the general population. Patients with epilepsy had a 3.5-fold higher risk of death as compared with the general population (SMR: 3.47, 95% CI: 2.46-4.91). The Cox proportional hazards regression model was used to assess relevant clinical contributions to death. Patients with an age-at-onset > or = 40 years had a 4-fold higher risk of death as compared with those with an earlier onset. The multivariate analysis revealed that age-at-onset between 40 and 59 years, tumor etiology, and being male increased the risk of death in epilepsy. One-third of the deaths in patients with age-at-onset between 40-59 years died of liver cirrhosis and hepatoma. Hepatitis B virus infection is endemic in Taiwan, and this is closely associated with liver cirrhosis and hepatoma. Whether anticonvulsants contributed to the hepatotoxicity that led to fatal liver disease in this group needs further investigation.     

Health behavior in psychiatric in-patients compared with a German general population sample

OBJECTIVE: To compare the health relevant behavior of psychiatric patients and the general population. METHOD: Health behavior of 363 psychiatric in-patients with ICD-10 diagnoses of schizophrenia, bipolar disorders, major depressive disorders and neurotic, and somatoform disorders was compared with health behavior of a representative sample of 7200 persons from German general population. RESULTS: Increased prevalence rates for smoking and illicit drug use were found for all diagnostic groups. Risk alcohol consumption was increased in patients with schizophrenia and depression. Smokers with schizophrenia had an excess cigarette consumption compared with general population. The number of unhealthy food habits was increased in all diagnostic groups, and the body mass index was found to be increased for patients with schizophrenia. Patients with depression were more physically active than general population. CONCLUSION: Poor health behavior is widespread in patients with all major psychiatric diagnoses. Interventions to reduce risk behavior and strengthen health preventive lifestyles are necessary.     

成年癫痫患者抑郁、焦虑状况及生活质量调查

目的调查成年癫痫患者抑郁、焦虑的患病率及可能的危险因素;评价抑郁及焦虑对癫痫患者生活质量的影响。方法采用Beck抑郁问卷(BDI)、贝克焦虑量表(BAI)及癫痫患者生活质量量表-31(QO-LIE-31中文版),对200例成年癫痫患者的抑郁、焦虑情况及生活质量进行评估。结果在200例癫痫患者中43.5%伴发抑郁,28.5%伴发焦虑,23%伴发抑郁及焦虑。发作频繁、无有薪职业是癫痫患者伴发抑郁的重要危险因素,无有薪职业是癫痫患者伴发焦虑的危险因素。抑郁组及抑郁伴焦虑组的QOLIE-31总分及各项评分均低于非抑郁非焦虑组(P=0.000);焦虑组的QOLIE-31总分(P=0.004)及发作的担忧(P=0.019)、认知功能(P=0.009)方面的得分均低于非抑郁非焦虑组。结论抑郁和焦虑是癫痫患者常见的精神共病,严重影响了癫痫患者的生活质量。积极控制发作、为癫痫患者提供更多的就业机会是改善癫痫患者生活质量的重要因素。     

早期帕金森病患者健康相关生活质量

目的 研究中国早期帕金森病(PD)患者健康相关生活质量(health related quality of life,HR-QOL)的特点;探讨运动症状和非运动症状对早期PD患者HR-QOL的影响.方法 在全国范围内共筛选出391例早期PD患者入组.采用统一帕金森病评分表(UPDRS)和Hoehn-Yahr评价运动症状,采用流行病学研究中心编制的抑郁量表(CES-D)、匹兹堡睡眠质量指数(PSQI)、疲劳量表(FSS)、阿尔茨海默病评定量表的认知部分(ADAS-Cog)和便秘量表分别对抑郁、睡眠障碍、疲劳、认知功能和便秘等非运动症状进行评价;采用36条目简化医疗结局调查问卷(SF-36)评价HR-QOL.比较PD患者与同龄健康老年人SF-36分值的差异.采用逐步多元线性回归分析深入探讨各种运动及非运动症状变量对HR-QOL的影响.结果 早期PD患者除SF-36躯体疼痛维度外,其余各维度分值较同龄健康老年人均下降.UPDRS第3部分分值(23.8±11.8)、Hoehn-Yahr分期(2.0±0.7)和强直分值(4.4±3.1)仅能解释SF-36总分变化的18.9%(R2=0.189).CES-D、FSS和PSQI分值等非运动症状变量引入回归方程后,SF-36总分可被解释的部分由18.9%增加至61.7%(R2=0.617).并且,引入CES-D分值后,SF-36总分可被解释的部分增加了43.3%(R2=0.433).结论 PD症状严重影响早期患者的HR-QOL.运动症状对HR-QOL存在影响,但影响作用有限.抑郁、疲劳和睡眠障碍这3个非运动症状是导致早期PD患者HR-QOL恶化的主要原因.其中,抑郁症状是HR-QOL恶化的最强预测因素.临床上,应重视非运动症状,运动和非运动症状兼治,才能真正提高疗效显著改善患者的HR-QOL.     

Long-term survival after epilepsy surgery compared with matched epilepsy controls and the general population

This study evaluates if there was a difference in long-term survival between epilepsy surgery patients, individually matched controls with intractable epilepsy, and controls from the general population. In a cohort study, we compared the survival of patients operated with epilepsy surgery in Norway 1948-1988 with: (1) a control group with prolonged medical treatment for intractable epilepsy individually matched for age, gender, and seizure type (n = 139), and (2) expected mortality for matched individuals in historical cohorts of the general population (n = 196). Survival was compared using Kaplan-Meier curves and stratified proportional hazards analysis. After on average 25 years of observation after surgery, there was no difference in survival between the epilepsy surgery group and the controls with intractable epilepsy (p = 0.18). The risk ratio for death after epilepsy surgery was 0.6 (95% CI 0.4-1.1; p = 0.08) compared with the control group. However, survival of epilepsy surgery patients was lower than that of a matching general population (p < 0.001), with a risk ratio for death of 6.2 (95% CI 3.1-12.6; p < 0.001). In this long-term study of a national cohort of epilepsy surgery patients, we found no beneficial effect of epilepsy surgery on survival compared with a control group of medically treated patients with intractable epilepsy. The mortality after epilepsy surgery was higher than expected in the general population.     

Predictors of general quality of life and the mediating role of health related quality of life in patients with schizophrenia

Introduction  The concept ‘quality of life’ (QoL) has become increasingly important as an outcome measure in the evaluation of services and in clinical trials of people with schizophrenia. This study examines the mediating role of health related quality of life (HRQoL) in the prediction of general quality of life (GQoL). Method  QoL and other patient- and illness characteristics (psychopathology, overall functioning, illness history, self-esteem and social integration) were measured in a group of 143 outpatients with schizophrenia. GQoL was measured by the Lancashire Quality of Life Profile and HRQoL was measured by the MOS SF-36. To test the temporal stability of our findings, assessments were performed twice with an 18-month interval. Results  We found that patient’s GQoL is predicted mainly by anxiety and depression and self-esteem and to a lesser extent by global functioning and social integration. At both time intervals HRQoL appeared to be a significant mediator of the relationship between anxiety and depression and self esteem versus patient’s GQoL. Conclusions  The results of this study are important for mental health professionals, as these provide more insight in the mechanisms by which they could improve the GQoL of their patients with schizophrenia. The results confirm that diagnosis and treatment of anxiety and depression in outpatients with schizophrenia deserves careful attention of clinicians. Also strategies and specific interventions to improve self-esteem of patients with schizophrenia are very important to maximise patient’s QoL.     

Correlates of health related quality of life in adult patients with spinal muscular atrophy

Introduction: To improve care for patients with spinal muscular atrophy (SMA), we assessed the physical and mental quality of life (QoL) in 62 adult patients with SMA. Methods: Physical component scores (PCS) and mental component scores (MCS) of the Short Form‐36 Health Survey (SF‐36) were obtained. Correlations with demographics, disease severity, and emotional distress were assessed. We used hierarchical multiple regression analysis to identify determinants of QoL. Results: PCS scores were lower, and MCS scores higher than in the healthy reference population. Patients with milder SMA types reported lower scores on several MCS domains. Motor skills scores and emotional distress explained 16% of the variance in PCS. SMA type and emotional distress explained 10% and 45% of the variance of MCS, respectively. Conclusions: Patients with milder forms of SMA tend to have a reduced mental QoL. Psychological interventions to reduce emotional distress may improve both mental and physical QoL. Muscle Nerve 54 : 850–855, 2016     

Changes in quality of life and self-perspective related to surgery in patients with temporal lobe epilepsy

PURPOSE: To evaluate changes in intractable epilepsy patients in terms of quality of life, depression, anxiety, stigma, and impact of epilepsy before and after surgery. METHODS: Twenty patients with intractable temporal lobe epilepsy who were waiting for surgery (pre-SAH group) and 21 patients who had already undergone surgery (post-SAH group) were studied. All patients received SF-36, Beck Depression Inventory, State-Trait Anxiety Inventory, stigma and impact of epilepsy inventories, and a form asking their own perspectives about epilepsy and surgery. RESULTS: Post-SAH group scored higher on all subscales of SF-36, with only RE scores being significantly better (t=-1.98, P=.05). Although depression, anxiety, and stigma scores were higher in pre-SAH group, only impact of epilepsy scores were significantly higher in pre-SAH group (t=-2.951, P=.005). Seizure frequency and comorbidity had significant effects on QOL where amount of AEDs and QOL were negatively related (r=-0.318, P<0.05). Both groups stated lack of independence and social activities as the main concern (48.8%) and recovery from epilepsy as the most important expectation from surgery (85.4%). Post-surgical group mentioned the difference in their life after surgery as independence and increase in social activities (47.6%). CONCLUSION: QOL of patients after surgery was found to be better than before surgery. Results also revealed that seizure frequency, comorbidity, and anti-epileptic medication affected health related QOL negatively. Impact of epilepsy levels was found to be higher among the pre-SAH patients. Finally, independence seemed to be the most important concern and gain for Turkish epilepsy patients.     

Fatigue in patients with sarcoidosis, compared with the general population

Objective

Fatigue is a significant symptom in sarcoidosis patients. The causes for this symptom are unclear. The aims of this study were to analyze age and gender differences in fatigue, compared with the general population, and to test the psychometric properties of two questionnaires measuring fatigue in sarcoidosis.

Method

A sample of 1197 patients diagnosed with sarcoidosis was examined in Germany with the Fatigue Assessment Scale (FAS) and the Multidimensional Fatigue Inventory (MFI).

Results

The percentages of patients exceeding the fatigue cut-offs were 70% (FAS) and 68% (MFI), respectively. While in the general population there is a nearly linear age trend (high fatigue scores with increasing age), among the patients there is only a very slight and nonlinear age trend. Female patients are more affected by fatigue than male patients, but this relationship is also true in the general population. Both questionnaires (FAS and MFI) are equally suited to test fatigue; their psychometric properties are good. They should not be replaced with a single question concerning tiredness.

Conclusion

The comparison to norm data is highly recommended for the evaluation of age and gender differences. Compared with the general population, young sarcoidosis patients are especially affected by fatigue.     

Relationship between mood related disorders and quality of life in a population of Dutch adult psychiatric outpatients

Our objective was to investigate explicitly the relationship between mood-related disorders (MRDs) and quality of life (QOL), while trying to overcome the limitations of earlier research. QOL scores of psychiatric outpatients with MRDs were compared with QOL scores of outpatients without MRD and a sample of the general Dutch population (GDP). QOL was assessed with the World Health Organization Quality of Life assessment instrument, long version (WHOQOL-100), and depressive symptoms were assessed with the Symptom Checklist-90 (SCL-90). Outpatients with MRD had lower scores on all aspects of the WHOQOL-100 compared with the GDP. Compared with outpatients without MRD, the outpatients with MRD scored lower on most aspects of the WHOQOL-100. Within the group with MRDs, patients with major depressive disorder (MDD) had lower QOL scores compared with patients with dysthymic disorder or adjustment disorder with depressed mood. Severity of MRD and MDD was negatively related to QOL. Comorbid personality disorders worsened QOL. Within the group with MRDs, common variance between depressive symptoms and QOL did not exceed 25%. MRDs are negatively related with QOL. Severity of MRD and comorbidity of personality disorders decrease QOL further. MRDs affect all domains and facets of QOL. The relationship found between MRDs and QOL was not caused by an overlap between the concepts depressive symptoms and QOL, shown by the relative small common variance between (depressive) symptoms and QOL.     

癫痫患者生活质量影响因素分析

目的 调查和分析影响癫痫患者生活质量的相关因素,为采取相应措施提高癫痫患者的生活质量提供理论依据.方法 选择自2007年7月至2008年12月在广州医学院第二附属医院癫痫中心就诊的门诊及住院癫痫患者65例,采用癫痫患者生活质量表-31(中文版)对患者进行问卷调查,以患者的年龄、性别、文化程度、发作类型、病程、认知功能、用药依从性、发作担忧作为自变量,以生活质量表-31(中文版)中相关评分作为应变量,多元线性回归分析应变量和自变量之间的线性关系.结果 文化程度、病程可以影响癫痫患者的记忆力(标准化回归系数分别为0.380、0.264);年龄可以影响患者的社会活动(标准化回归系数为-0.303);性别影响患者的发作(标准化回归系数为0.332).结论 影响癫痫患者生活质量的因素是年龄、性别、病程、文化程度等,且病程与文化程度影响最大.     

Health-related quality of life of patients with epilepsy in Turkey

The aim of this study was to measure the health related quality of life (HRQOL) of epilepsy patients and to compare it with that of a healthy control group. The evaluation included the effects of the type of seizure, duration of seizure and medical treatment on the quality of life of the patients. The group studied consisted of 221 participants (121 epilepsy patients and 100 healthy control individuals) who completed a sociodemographic data form and who were administered the World Health Organization Quality of Life (WHOQOL-100) scale. The epilepsy patients had statistically lower physical health, psychological well-being, level of independence and global HRQOL than participants in the control group (p < 0.05). The analysis of variance showed that the partial epilepsy subgroup had significantly lower averages for all the quality-of-life subfields except for the social relationship dimension. On regression analysis, being married, having a generalized type of seizure and being treated with fewer medications were all related to higher scores on the HRQOL. Epilepsy is a disease that has neurological, psychiatric and psychosocial dimensions that should be evaluated using a multidisciplinary approach.