Clinical Factors Influencing Quality of Life in Patients with Epilepsy

BACKGROUND: Epilepsy has been known to adversely affect a patient's quality of life (QOL). We investigated the status of QOL and tested the influences of clinical factors upon QOL in epileptic patients. METHODS: We evaluated 125 adult patients (mean age, 30.4 years, male:female=1:0.86) with epilepsy. The demographic, social (marriage, employment, religion, education duration), and clinical data (seizure onset age, seizure pattern during the last 1 year, treatment duration, number of antiepileptic drug) were obtained. Quality of life in epilepsy-31 (QOLIE-31) and Beck Depression Inventory-Korean version (KBDI) were used. The relationships of demographic, social, and clinical factors with QOL in epileptic patients were evaluated. RESULTS: The mean subscores of QOLIE-31 items were 52.6 (medication effects), 50.9 (cognitive functioning), 50.9 (social functioning), 50.5 (energy/fatigue), 48.4 (seizure worry), 46.8 (overall QOL), and 45.7 (emotional well-being), and the overall score was 49.6. Sex, marriage, religion, and duration of treatment did not affect QOL. The age of patients had a weak linear positive correlation with overall QOL and emotional well-being. Employed patients had a significantly high score in overall QOL, emotional well-being, cognitive functioning, social functioning, and overall score. The patients given polytherapy had lower scores of QOLIE-31 items except seizure worry and energy/fatigue. Seizure free patients had significantly higher scores in seizure worry, overall QOL, social functioning, and overall score. Depression negatively influenced all subscales and overall score. CONCLUSIONS: Age, employment state, number of antiepileptic drugs, seizure pattern, and depression were significant clinical factors affecting QOL in patients with epilepsy.

Personality Evaluation of Intractable Epilepsy Patients and the Postsurgical Change / 대한간질학회지

BACKGROUND: Epilepsy patients may have a various whole gamut of psychological problems attending upon, in part or in whole, epileptic seizure focus. To investigate psychological problems related to epileptic focus and their postsurgical change, personality evaluation was performed in medically intractable epilepsy patients before and after the epilepsy surgery. METHODS: There were 103 temporal lobe epilepsy (TLE) patients with or without hippicampal sclerosis (HS) and 22 extratemporal lobe epilepsy (XTLE). We used MMPI as an objective method of assessing emotional state and personality profile of the patients. The preoperative MMPI scales were compared between the TLE group and the XTLE group, between TLE with HS group and without HS group (NHS), and right and left TLE groups. In addition, the postsurgical changes of MMPI scales were analyzed upon only 31 TLE patients who had preoperative and postoperative MMPI RESULTS: First of all, in terms of mean value of each scale, all results observed were within normal range. When these results were analyzed using t-test, the scores of social introversion were significantly higher in HS group than in NHS group. Secondly, there were significant postoperative decrease of depression, hypochondriasis, psychasthenia, schizophrenia scales in HS groups and mascu-linity-frminity scale in NHS group. There was no significant difference of MMPI scales between TLE and XTLE CONCLUSION: The results of this study that hippocampal sclerosis may affect the preoperative personality and the removal of pathologic hippocampus may improve MMPI scales.

Combined Facial and Abducens Nerve Palsy in Pontine Infarction

Isolated cranial neuropathies involving the facial nerve are very rare manifestations of pontine infarction, and have not been described in paramedian pontine infarction. We report a 67-year-old woman who developed sudden and long-lasting right facial nerve paralysis accompanied by transient ipsilateral abducens nerve palsy. Brain magnetic resonance imaging showed two discrete simultaneous infarctions in the right inferior paramedian pontine area, which seemed to correspond to the facial nerve fascicle and the abducens nerve fascicle, respectively. Paramedian pontine infarction can be one of the causes of facial nerve palsy and present as an isolated or predominant sign.

A case of CNS Cryptococcosis with internucleat ophthalomoplegia

Ocular disturbances related to cranial nerve lesion or increased intracranial pressure are well known in cryptococcal meningitis, but internuclear ophthaloplegia is very rare and only two cases have been reported to our knowledge. We report the third patient of internuclear ophthalmoplegia in cryptococal meningitis. The internuclear ophthalmoplegia in our case persisted for one year with a demonstrable lesion in brain MRI, in contrast to the other cases in which intranuclear ophthalmoplegia was transient and no responsible lesion was observed.