Family and sexual life in people with epilepsy

Having epilepsy is much more than having seizures. Epilepsy can have a severe negative effect on quality of life, affecting social relationships, academic achievement, housing, employment, and the ability to live and function independently. We undertook a cross-sectional study in a tertiary epilepsy center in Lithuania, aiming to assess the influence of epilepsy and aspects relating to epilepsy (employment, stigma, anxiety) on patients and their families, and to estimate their quality of family life and sexual functioning. We asked patients to complete a questionnaire about their socio-demographic situation, their seizure types and antiepileptic medications, and their quality of family and sexual life. Our results confirmed that epilepsy seriously influences family life. One third of our patients are lonely and half are childless. Epilepsy leads to difficulty in finding a job, especially for men, and unemployment affects their status in the family. People with epilepsy are uncomfortable interacting with those of the opposite sex and tend to conceal their medical condition from their partner. One third have sexual dysfunction, yet only a quarter of them seek professional help. There is a clear need to improve self-confidence and to reduce social stigma in people with epilepsy, and to encourage them to discuss their problems with specialists.     

Perceived stress and its predictors in people with epilepsy

ObjectivePerceived stress in people with epilepsy (PWE) is one of the major precipitants for seizures. We investigated the degree of perceived stress in PWE and its predictors. We also aimed to reveal the interrelationships among the predictors.MethodsThis was a case–control study. Consecutive patients visiting a tertiary care epilepsy clinic completed self-reported questionnaires including the Perceived Stress Scale (PSS), Revised Stigma Scale (RSS), Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), Generalized Anxiety Disorder — 7 (GAD-7), and short forms of the Patient-Reported Outcomes Measurement Information System — Sleep Disturbance (PROMIS-SD) and Patient-Reported Outcomes Measurement Information System — Sleep-Related Impairment (PROMIS-SRI) scales.ResultsThe mean score of the PSS was significantly lower in patients with well-controlled epilepsy (WCE) and higher in those with uncontrolled epilepsy compared with controls. Although several factors including demographic, socioeconomic, psychosomatic, and epilepsy-related factors were associated with the PSS score, the strongest predictor for the PSS score was the K-NDDI-E score, followed by the PROMIS-SRI score, the GAD-7 score, and seizure control. Psychosomatic factors exerted both a direct effect on the PSS score and an indirect effect on the PSS score through seizure control.ConclusionRapid detection and appropriate management of psychiatric and sleep-related problems in PWE may lessen stress and aid in preventing further seizures.     

Association of perceived stress with sleep duration and sleep quality in police officers

The objective was to investigate associations ofperceived stress with sleep duration and quality among 430 police officers. Perceived stress was assessed using the perceived stress scale. Sleep duration and quality were assessed using the Pittsburg sleep quality index questionnaire. Mean hours of sleep were determined across quartiles of perceived stress using ANOVA/ANCOVA. Logistic regression was used to obtain odds ratios and 95% confidence intervals for poor sleep quality across perceived stress quartiles. Mean age was 42.1 years. Perceived stress was inversely associated with sleep duration among certain groups: men (p = 0.004), higher-ranked officers (p = 0.002), those with higher depressive symptoms (p 0.097), no military experience (p = 0.006), and higher workload (p = 0.003). Gender, police rank, depressive symptoms, and workload each significantly modified the association between stress and sleep duration. Prevalence of poor sleep quality increased with higher levels of perceived stress; the trend was significant among men only (p < 0.0001), and gender significantly modified this association (interaction p = 0.015). Compared to those in the first quartile of perceived stress, women in the fourth quartile were almost four times and men almost six times more likely to have poor sleep quality. Perceived stress was inversely associated with sleep duration and positively associated with poor sleep quality.     

Neural response to stress and perceived stress differ in patients with left temporal lobe epilepsy

Patients with epilepsy are often able to predict seizure occurrence subsequent to an acute stress experience. However, neuroimaging investigations into the neural basis of this relationship or the potential influence of perceived life stress are limited. The current study assessed the relationship between perceived stress and the neurobehavioral response to stress in patients with left temporal lobe epilepsy (LTLE) and healthy controls (HCs) using heart rate, salivary cortisol level, and functional magnetic resonance imaging and compared these effects between HCs and LTLE. Matched on perceived stress levels, groups of 36 patients with LTLE and 36 HCs completed the Montreal Imaging Stress Task, with control and stress math task conditions. Among LTLEs, 27 reported that prior (acute) stress affected their seizures (LTLES+), while nine did not (LTLES?). The results revealed that increased perceived stress was associated with seizure frequency in LTLE. Further, cortisol secretion was greater in LTLE, but did not vary with perceived stress as observed in HCs. A linear mixed‐effects analysis revealed that as perceived stress increased, activation in the hippocampal complex (parahippocampal gyrus and hippocampus) decreased during stressful math in the LTLES+, increased in HCs, but did not vary in the LTLES?. Task‐based functional connectivity analyses revealed LTLE differences in hippocampal functional connectivity with sensory cortex specific to stressor modalities. We argue that the current study demonstrates an inhibitory hippocampal mechanism underlying differences in resilience to stress between HCs and LTLE, as well as LTLE patients who report stress as a precipitant of seizures.     

Sociocultural and psychological features of perceived stigma reported by people with epilepsy in Benin

Purpose: Stigma is a major burden of epilepsy. In sub‐Saharan Africa the few studies that addressed epilepsy stigma emphasize enacted, rather than perceived, stigma. This inattention may compromise clinical management and delay help seeking, thereby contributing to the treatment gap. We assessed perceived stigma and identified sociocultural and psychological factors explaining greater stigma among people with epilepsy (PWE) in Benin. Methods: PWE included in this study were ascertained using a door‐to‐door survey in the general population in a Beninese rural area. We applied both qualitative and quantitative research methods to assess stigma and patient’s experience and beliefs. An Explanatory Model Interview Catalogue (EMIC) and verbally administered questionnaires provided data for demographic, clinical, and sociocultural features. Sociocultural features were evaluated in terms of illness‐related experience and sociocultural representations of epilepsy. Depression and anxiety were also screened. Results: Eighty PWE were included. About 68.7% reported feeling stigmatized. Multivariate regression revealed that factors independently associated with perceived stigma were experience of social isolation (p < 0.001), experience of marital problems (p < 0.01), and presence of anxiety disorder (p < 0.01). Discussion: Perceived stigma is an important issue in epilepsy in Benin. Social factors seem to be more influential than sociocultural representation of epilepsy. Insofar as research is needed in other African countries to determine the nature and relevant features of stigma to improve treatment and control.     

Physical activity in people with epilepsy: A systematic review

This study aimed to systematically review studies focusing on levels of physical activity (PA) in people with epilepsy (PWE) compared with non-epilepsy controls, and identify factors associated with PA in PWE. Intervention studies were also reviewed to consider the effects of psychological interventions on levels of PA, and the effects of PA-based interventions on seizure activity, psychiatric comorbidity, and health-related quality of life (HRQoL). PRISMA guidelines were followed. Searches were conducted using PubMed, Cochrane Controlled Register of Trials, PsycINFO, and Embase. Forty-six studies met inclusion criteria, including case-control, cross-sectional, and intervention studies. Assessment measures included questionnaires, activity trackers, and measures of physiological fitness. Twelve of 22 (54.5%) case-control studies utilizing self-report questionnaire measures reported that PWE were performing lower levels of PA, less likely to be engaging in PA, or less likely to meet PA guidelines than controls. The remaining studies did not find a difference between PWE and controls. Eight of 12 (67%) case-control studies utilizing exercise/fitness tests reported that PWE performed significantly poorer than controls, whereas in two studies PWE performed better than controls. One of three studies investigating the relationship between PA and seizure frequency found that increased self-reported PA was associated with having fewer seizures, whereas two did not find a significant relationship. All seven cross-sectional studies that included measures of HRQoL and depression/anxiety found a positive relationship between levels of PA and HRQoL/reduced levels of depression and anxiety. All four studies that used PA-based interventions demonstrated improvements in levels of PA and increased HRQoL. Study quality was almost universally low. In conclusion, there is some evidence that PWE engage in less PA than peers, and that interventions can improve PA levels and HRQoL. However, there is a need for more robust study designs to better understand PA in individuals with epilepsy.     

Seizure-related vehicular crashes and falls with injuries for people with epilepsy (PWE) in northeastern Thailand

This cross-sectional study aimed to determine the number and types of falls and vehicular crashes with injuries , as well as some specific behavioral associations in people with epilepsy (PWE) in northeastern Thailand. Two hundred and three patients with epilepsy were randomly recruited from the university epilepsy clinic in Khon Kaen, who then completed an interview and a questionnaire. It was found that 84.5% of the patients were operating a vehicle on a regular basis (more than 3 days a week), and 21.6% of those had been in a vehicle crash. Additionally, 25.6% of the patients had been involved in falls with injuries. Forty-three percent of the respondents had been involved in either a vehicular crash or a fall with an injury, with 39.7% of the accidents resulting in moderate to severe injuries. Medication compliance was estimated at 66%, while 59.1% said that they had little or no control over their seizures, and more than half the patients did not feel confident about their ability to take care of themselves or to take their antiepileptic drugs (AEDs) properly. In a multivariate model, the following factors significantly increased the risk of being in either a vehicular crash or a fall with an injury: being single, attaining a secondary or higher education, exercising at least three times a week, napping every day or more frequently, and having poor seizure control. The results of this study suggest that patients' poor medication adherence and lack of confidence in managing their seizures may contribute to accidents. Patients with epilepsy should be counseled to seek less risky behaviors and try to attend classes that provide education on AED management.     

Self-reported anxiety and sleep problems in people with epilepsy and their association with quality of life

Comorbidities are common in epilepsy, and their role in quality of life (QOL) is receiving increasing scrutiny. Considerable attention has been focused on the role of depression, the most common comorbidity, with rather less attention paid to its frequent concomitant, anxiety, and other conditions known to be at increased prevalence among people with epilepsy (PWE) when compared to the general population. In this paper, we report findings from a UK-based survey in which we examined self-reporting of two common comorbidities, anxiety and sleep problems, factors associated with them, and their role in QOL in people with and without epilepsy.Data were obtained via mailed questionnaires, supplemented by an internet survey, from PWE and age- and gender-matched controls. Based on self-reported symptoms, PWE were at higher risk of anxiety and sleep problems. Contributory factors for anxiety included poorer general health, worry about seizures, and self-reported antiepileptic drug (AED) side effects. Good social support emerged as protective for anxiety in PWE. Nighttime sleep problems were very common even in controls but were further elevated in PWE. Antiepileptic drug adverse events emerged as an important contributory factor for sleep problems. Trait anxiety emerged as significant for defining overall QOL, and its importance over state anxiety supports the notion of anxiety in PWE as a primarily premorbid condition. In contrast, sleep quality was not consistently predictive of QOL. Our study has important implications for clinical management, emphasizing the need for a holistic approach to address wider patient-reported problems as well as any epilepsy-specific ones.     

Physiological and electroencephalographic responses to acute exhaustive physical exercise in people with juvenile myoclonic epilepsy

Although the available evidence suggests that exercise may positively affect epilepsy, whether this effect is applicable to different types of epilepsy has not been established. Physiological responses during rest, acute physical effort, and a recovery period were studied by concomitant analysis of cerebral electric activity using EEGs in subjects with juvenile myoclonic epilepsy (JME) and healthy controls. In addition, level of habitual physical activity, body composition, and 1 week of actigraphy monitoring data were evaluated. Twenty-four subjects (12 with JME and 12 controls) participated in this study. Compared with the control group, the JME group had a significantly lower O₂ at rest (13.3%) and resting metabolic rate (15.6%). The number of epileptiform discharges in the JME group was significantly reduced during the recovery period (72%) compared with the resting state. There were no significant differences between the JME and control groups in behavioral outcomes and sleep parameters evaluated by actigraphy monitoring. The positive findings of our study strengthen the evidence for the benefits of physical exercise for people with JME.     

Cardiorespiratory and electroencephalographic responses to exhaustive acute physical exercise in people with temporal lobe epilepsy

We evaluated physiological and electroencephalographic responses during a cardiopulmonary exercise test (CPET) in people with epilepsy. Behavioral outcomes of people with epilepsy were also compared with those of healthy controls. Thirty-eight subjects (19 people with epilepsy and 19 controls) participated in this study. Poor outcomes in the behavioral analyses (habitual level of physical activity and quality of life) were observed in the people with epilepsy. With respect to the CPET, V.O(2max) (14.6%) and V.O(2) at anaerobic threshold (16.1%) were significantly lower in the epilepsy group than in the control group. Although not statistically significant, a decrease in the number of epileptiform discharges was observed between the rest state and exercise (82%) and between the rest state and recovery period (74%). In conclusion, the lower aerobic fitness in people with epilepsy observed may be associated with their sedentary habits. Moreover, our findings reinforce the hypothesis that exhaustive exercise is not a seizure-inducing factor.     

Nocturnal sleep, cardiovascular function, and adrenal activity following maximum-capacity exercise

Eight subjects performed a treadmill test of their maximal aerobic capacity (VO2max) to determine whether exercise which is maximally stressful but relatively low in total energy expenditure may affect nocturnal sleep. The test was performed at 16.00 h on day 3 of the study, with day 1 as adaptation, day 2 as baseline and day 4 as a carryover night. Changes observed after exercise included a decrease in the duration of the first REM sleep period, an elevation of heart rate in the first 2 h of sleep, a reduction in norepinephrine excretion and an increased excretion of dopamine. Comparisons of sleep alterations in 4 subjects who exercised regularly (active group) with 4 subjects who took no regular exercise revealed differences in the first sleep cycle. Active subjects displayed an increased duration of SWS coupled with an increased latency to first REM onset. Non-active subjects, by contrast, displayed a shortened REM latency and duration of SWS. These results indicate that short-term maximum exercise may induce significant alteration of the temporal distribution of SWS with differences in response seen between regular exercisers and non-exercisers.     

Anxiety disorders in people with epilepsy

Anxiety disorders are frequent, though probably underdiagnosed, comorbidities in epilepsy. Epilepsy and anxiety may share common neurobiological correlates as shown in animal models and suggested by studies demonstrating anxiety disorders before the manifestation of epilepsy. Comorbid anxiety disorders have a major impact on the affected patients' quality of life and may increase the risk for suicidality. Successful treatment of the epilepsy may alleviate anxiety symptoms. Treatment of anxiety is based on selective serotonin reuptake inhibitors, benzodiazepines (although only as second-line choices), and psychotherapy. Specific AEDs (especially pregabalin) have been shown to have anxiolytic properties. This paper is aimed at reviewing anxiety disorders in patients with epilepsy discussing current scientific evidence about pathophysiology, clinical aspects, and treatment strategies.     

Reproductive and sexual dysfunction in men with epilepsy

Disturbances of reproductive and sexual health are common in people with epilepsy. Their etiology is not well understood but appears to be multifactorial, and both epilepsy itself and drugs used to treat it are implicated. Physiologically, sex steroid hormone levels, the hypothalamic-pituitary axis, and testicular function can be affected in men with epilepsy. Psychosocial complications associated with epilepsy can also affect reproductive health and sexuality. Clinicians need to investigate such problems carefully, both because of their multifactorial nature and because patients and physicians alike may often fail to recognize or be reluctant to acknowledge them; in particular, patients whose epilepsy had its onset before puberty may lack subjective awareness of impairments of sexual response and function. Treatments for reproductive and sexual dysfunction in men with epilepsy have been inadequately studied. Modalities such as medications for erectile dysfunction and surgery may be useful. Therapy with exogenous testosterone and an aromatase inhibitor may be helpful for men with epilepsy and sexual dysfunction due to testosterone deficiency.