The Influence of Education on Knowledge of Their Disorder and Quality of Life in Patients with Epilepsy / 대한간질학회지

PURPOSE: The education of the patients is an effective component of comprehensive care, especially in patients with epilepsy. We developed an epilepsy educational program designed to improve the knowledge and understanding of the natural clinical course, the treatment, and prognosis of epilepsy. We evaluated the efficacy of this educational program to epilepsy patient's knowledge of their disorder and quality of life. METHODS: We studied 224 patients with epilepsy from Dongsan Epilepsy Center. All patients completed the Knowledge and Quality of Life in Epilepsy-31 (QOLIE-31) questionnaire before a one-day educational program was completed. Six months after the educational program was given, patients completed the same questionnaire. The results of the two surveys were compared. RESULTS: In the initial questionnaire, about 60% of the patients thought that epilepsy is not related with head trauma. About 40% of the patients thought that epilepsy is a genetic disorder. Over 80% of the patients thought that behavior changes are not related to epilepsy. Over 90% of the patients had correct responses about taking antiepileptic drugs. However, only 60% of the patients had their ideas regarding proper social activity correct. After completing the educational course, the results of the follow-up questionnaires were markedly improved concerning the patients' knowledge of epilepsy. In contrast, the quality of life measures changed a little. CONCLUSION: An epilepsy educational program for patients improves their knowledge of epilepsy. This study was performed with only one education workshop, which is not sufficient to improve the quality of life measures. A well-regulated, systematic educational program is needed to efficiently improve the lives of epileptic patients.

Needs Assessment for Information and Support of Parents of Children with Epilepsy / 기본간호학회지

PURPOSE: This study investigated the need for information and social support in parents of children with epilepsy. METHODS: A total of 119 parents of children with epilepsy were recruited and asked to fill out questionnaires. RESULTS: Of 119 parents, two-third reported that they received full and sufficient information about their child's disease and its management but one-third felt the information was insufficient and incomplete. Most parents (62.2%) felt at loss when their child had a seizure, either at home or at school. They wanted information on the causes of seizures, adequate steps deal with seizure and steps they should take to become adequate and supportive parents for their children. However, most parents were reluctant to disclose the disease or to receive support from outsiders. CONCLUSION: Regardless of the fact that most parents received sufficient information about the management of epilepsy, they felt at a loss when their child had a seizure attack. Therefore nurses should give specific instruction on seizure management and assess the needs of parents on a regular basis.

Ictal Vomiting Associated with Temporal Lobe Epilepsy of Dominant Hemisphere

Ictal vomiting is a rare clinical manifestation of temporal lobe epilepsy. This manifestation is considered a clinical lateralizing sign pointing toward seizure activity within the nondominant temporal lobe. However, we have experienced a case of ictal vomiting associated with temporal lobe epilepsy within the dominant hemisphere. The ictal vomiting occurred early in the course of the seizure when rhythmic discharges predominantly involved the left temporal lobe. This patient underwent a left anterior temporal lobectomy and experienced markedly reduced seizure frequency for more than 2 years.

Sleep Disorders In Maintenance Dialysis Patients with End-Stage Renal Disease

BACKGROUND: Patients with end-stage renal diseases (ESRD) have an increased risk of sleep problems such as daytime sleepiness, insomnia, restless legs syndrome (RLS), and obstructive sleep apnea syndrome (OSAS). However, presently there is limited data available, particularly in Asia. METHODS: To investigate the prevalence of sleep complaints in ESRD patients, 100 patients at the maintenance hemodialysis (HD) and 100 patients at the continuous ambulatory peritoneal dialysis (CAPD) were surveyed using a specific questionnaire. RESULTS: Patients had a mean age of 50.58+/- 14.03 years, with a mean body mass index (BMI) of 21.8+/-3.5 kg/m2. The mean duration of dialysis was 44.56 +/-49.74 months. Fifty-six percent of the dialysis patients were poor sleepers. Daytime sleepiness occurred in 24% to 34% of the patients, and insomnia occurred in 35% of the patients, while restless legs syndrome was reported in 44% of the patients. The higher BMI group had a lower risk for insomnia when compared to the lower BMI group (OR=0.11, 95% CI=0.03-0.46). The OR of depression for insomnia was 2.8 (95% CI=1.02-7.69). There was no difference in the prevalence of sleep disturbances between the HD and CAPD patients groups. CONCLUSIONS: Complaints of sleep disturbance and daytime somnolence are very common in dialysis patients and likely contribute to the impaired quality of life experienced by many of these patients. Identifying and treating the sleep complaints in dialysis patients could contribute significantly to their quality of life and avoid potential side effects of nonspecific sedatives.

Sleep Disorders In Maintenance Dialysis Patients with End-Stage Renal Disease

BACKGROUND: Patients with end-stage renal diseases (ESRD) have an increased risk of sleep problems such as daytime sleepiness, insomnia, restless legs syndrome (RLS), and obstructive sleep apnea syndrome (OSAS). However, presently there is limited data available, particularly in Asia. METHODS: To investigate the prevalence of sleep complaints in ESRD patients, 100 patients at the maintenance hemodialysis (HD) and 100 patients at the continuous ambulatory peritoneal dialysis (CAPD) were surveyed using a specific questionnaire. RESULTS: Patients had a mean age of 50.58+/- 14.03 years, with a mean body mass index (BMI) of 21.8+/-3.5 kg/m2. The mean duration of dialysis was 44.56 +/-49.74 months. Fifty-six percent of the dialysis patients were poor sleepers. Daytime sleepiness occurred in 24% to 34% of the patients, and insomnia occurred in 35% of the patients, while restless legs syndrome was reported in 44% of the patients. The higher BMI group had a lower risk for insomnia when compared to the lower BMI group (OR=0.11, 95% CI=0.03-0.46). The OR of depression for insomnia was 2.8 (95% CI=1.02-7.69). There was no difference in the prevalence of sleep disturbances between the HD and CAPD patients groups. CONCLUSIONS: Complaints of sleep disturbance and daytime somnolence are very common in dialysis patients and likely contribute to the impaired quality of life experienced by many of these patients. Identifying and treating the sleep complaints in dialysis patients could contribute significantly to their quality of life and avoid potential side effects of nonspecific sedatives.

The Reliability and Validity of Korean QOLIE-31 in Patients with Epilepsy / 대한간질학회지

BACKGROUND: To develop a Korean version of the QOLIE-31 and to confirm its psychometric properties. METHODS: The QOLIE-31 was adapted to Korean language through a translation-back translation procedure. Data were collected from 397 adult epilepsy patients. Patients were administered the Quality of Life in Epilepsy Inventory-31 (QOLIE-31), Korean Wechsler Intelligence Scale (KWIS), the Functional Assessment of Cancer Therapy-General (FACT-G), state scale of the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiological Studies-Depression Scale (CES-D). We assessed internal consistency and test-retest reliabilities and construct validity. RESULTS: Cronbach's alpha ranged from 0.69 to 0.86, and test-retest reliability was between 0.50 and 0.71, demonstrating that the items of OOLIE-31 are internally consistent and temporally stable. Pearson's correlations among the QOLIE-31 and emotional well-being, state anxiety, and depressive symptoms were high. Most QOLIE-31 sub-scales discriminated well between patients according to seizure frequency, number of antiepileptic drugs, employment, economic status and depressive symptoms. CONCLUSION: The Korean version of the QOLIE-31 was reliable, and showed construct validity comparable with the original U.S version. Results confirmed that the QOLIE-31 can be applied as one of the specific measures of quality of life in Korean epilepsy patients.

Clinical, Electrophysiological, and Genetic Analysis in a Family with Autosomal Dominant Nocturnal Frontal Lobe Epilepsy

BACKGROUND: Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is a distinct epilepsy syndrome and a genetically heterogeneous disorder linked to chromosomes 20q13.2, 15q24, and 1p21. Missense and insertion mutations in neuronal nicotine acetylcholine receptor 4 (CHRNA4) and 2 (CHRNB2) genes have been found in families with ADNFLE. METHODS: Clinical, EEG-Video monitoring, and neuropsychologic study in a family with ADNFLE were tested. For detect of mutation gene, polymerase chain reaction for CHRNA4 gene and CHRNB2 gene, single strand conformational polymorphism (SSCP) analysis and DNA sequencing were done. RESULTS: Among 15 living family members in three generations, nine had seizures. EEG-Video monitoring showed ictal epileptiform discharges genetically or regionally in frontal, frontocentral, frontotemporal, or temporal areas and less frequently no epileptiform discharges or non-specific generalized slowing. Two affected individuals demonstrated interictal temporal spikes, whereas the others were normal. Neuropsychological study showed mental retardation and decreased frontal executive function in five affected individuals. A cytosine to thymine exchange (755C>T; S252L) in exon 5 of the CHRNA4 gene was found on all affected individuals except in an individual who wasn 't tested, but this change was absent in those without epilepsy. CONCLUSIONS: This is the first study of genetically confirmed ADNFLE in a Korean family, who had mental retardation and various EEG abnormalities, ictally and interictally.

The Characteristics MMPI of Patients with Medically Refractory Epilepsy

BACKGROUND: It is debatable whether psychiatric problems are overrepresented in the epileptic patient population. In addition, the significance of MMPI elevations in epileptic patients is still uncertain. This study attempted to find out MMPI profile characteristics of patients with medically refractory epilepsy (MRE). METHODS: MMPI was administered to 172 MRE patients and 139 normal controls. RESULTS: In terms of the mean value of MMPI scales, the MRE patients group had normal mean values comparable to the normal control group. However, the MRE patients could be classified into three subgroups by a multivariate cluster analysis, which include a subgroup with normal profile group (41% of patients), neurotic profile group (elevated Hs-D-Hy scales; 19% of patients), and psychiatric profile group (elevated Pa-Pt- Sc & Hs-D-Hy scales; 40% of patients). CONCLUSIONS: This study shows that the majority of MRE patients have abnormal MMPI profiles and suggests that psychiatric disorders or problems might be common in MRE patients. (J Korean Neurol Assoc 19(3):226~231, 2001)

Quadruple Thera py of Behcet's Disease

Behcet's disease is a multisystematic inflammatory disorder affecting eyes. Visual loss is the most serious effect of Behcet's disease with posterior segment involvement.Because of the disorder's devastating visual consequences, its treatment has received considerable attention.Since the treatment of Behcet's disease has often been unsatisfactory, many different types of treatment have been attempted. We retrospectively reviewed the charts of 28 patients with severe ocular Behcet's disease involving posterior segment.The patients with posterior segment involvement were initially treated with triple regimen (corticosteroid, colchicines, and azathioprine).If intraocular inflammation does not resolve or the inflammatory process recurs, combination with low doses of cyclosporine should be considered (quadruple therapy).Over the course of therapy, visual acuity improved in 25 of 51 eyes (49.01%), remained stable in 14 of 51 eyes (27.45%), and declined in 12 of 51 eyes (23.52%).It improved or maintained the visual acuity in 39 of 51 eyes.There were no serious side effects attributable to triple or quadruple therapy that required withdrawal. The use of corticosteroids, colchicines, azathioprine, and cyclosporine may improve therapeutic efficacy and limit the adverse drug effects, and this combination method appears to be an effective treatment for the ocular complications of Behcet's disease.