ABSTRACT
Objective To investigate the effect of family factors on the prognosis of patients with epilepsy and the relationship between family factors and clinical characteristics of epilepsy.Methods Data were collected from 107 patients definitely diagnosed with epilepsy who were treated by antiepileptic drugs for at least two years.All the patients were divided into good or poor prognosis group according to whether achieving at least one year free of seizures.The clinical and family data were colleeted.The questionnaire Family Adaptability and Cohesion Evaluation Scale-Ⅱ-Chinese Version containing 30 items was used for patients and the Epilepsy Knowledge Questionnaire containing 34 questions for primary caregiver.We compared the clinical and family factors between the two groups to identify the predictors of poor control of seizures with univariate and multiple Logistic regression,and observed the relationship between family factors and clinical features such as course,type of seizure,seizure frequency,etc,with Pearson correlation analysis.Results Patients with poor prognosis were more likely to have interictal epileptiform discharges (IEDs),multidrug treatment and pre-treatment seizure frequency of more than once monthly (84.6％ (44/52) vs 50.9 ％ (28/55),x2 =13.797,P =0.000;63.5 ％ (33/52) vs 34.5 ％ (19/55),x2 =8.947,P =0.003;38.5％ (20/52) vs 5.5％ (3/55),x2 =17.257,P =0.000).Family in rural area,unbalanced family type,number of family members were much more in poor prognosis group than in good prognosis group (51.9％ (27/52) vs 25.5 ％ (14/55),x2 =7.923,P =0.005;80.8 ％ (42/52) vs 49.1％ (27/55),x2 =11.712,P=0.000;4.1 ± 1.1 vs 3.6 ±0.8,t=2.631,P=0.010).And average family income,education level of father,the level of epilepsy knowledge of primary caregiver were significantly lower in poor prognosis group than in good prognosis group (19/20/13 vs 11/17/27,x2 =7.198,P =0.027;15/30/7 vs 4/34/17,x2 =10.709,P =0.005;36/11/5 vs 15/25/15,x2 =19.022,P =0.000).Multiple Logistic regression analysis demonstrated that IEDs (OR =12.332,95％ CI 2.756-55.190,P =0.001),pretreatment seizure frequency of more than once monthly (OR =8.401,95％ CI 1.573-44.884,P =0.013)were clinical risk factors of unfavorable prognosis;more family members (OR =3.021,95％ CI 1.554-5.870,P =0.001),poor epilepsy knowledge of primary caregiver (OR =3.392,95％ CI 1.304-8.821,P=0.012) and unbalanced family type (OR=4.794,95％ CI 1.217-18.894,P=0.025) were independent family risk factors of poor prognosis.The level of epilepsy knowledge of primary caregiver was inversely associated with duration (r =-0.237,P =0.014).Conclusions The prognosis of epilepsy is not only affected by clinical factors,but also by family factors.More family members,poor epilepsy knowledge of primary caregiver and unbalanced family type are independent risk factors of unfavorable prognosis.The poorer epilepsy knowledge the primary caregivers have,the longer duration the disease has.
ABSTRACT
Objective To investigate precipitants of epileptic seizure, and to explore the correlation between various precipitants and relationship between precipitants and clinical features of epilepsy.Methods Data were collected from 154 patients attending a tertiary-care epilepsy clinic of Nanjing Brain Hospital between April 2015 and April 2016.The patients with epilepsy were older than 16 years, had a clinical history of one year or more, and one seizure at least a year and one seizure at least in the latest three months.An enclosed questionnaire was combined with open interview to identify and characterize seizure precipitants and clinical characteristics of patients.Patients were asked respectively whether there were some precipitants three months before and during last three months.Correlation between seizure precipitants and relationship between precipitants and clinical characteristics, such as age, gender, course, seizure frequency and so on, were calculated.Results A total of 125 (81.2%) participants reported at least one precipitant.Common precipitants (in descending order) were as follows: emotional stress (56.0%), sleep disorder (38.4%), fatigue (27.2%), missed medication (20.0%).There were one to six different precipitants for one patient, and 60.8% of patients had two or more precipitants.There was a correlation between emotional stress and sleep disorders as well as fatigue (χ2=4.665, 8.668;P<0.05).Patients with idiopathic epilepsy were more sensitive to sleep disorders.There was no relationship between total precipitants and clinical features such as age, gender, age of onset, duration, type of seizure, seizure frequency, number of drug taking and so on.Conclusions Seizure precipitants were found widespread.The most common precipitants were found to be emotional stress, sleep disorders, fatigue and missed medication.There existed a correlation between emotional stress and sleep disorders as well as fatigue.There was no connection between total precipitants and patient′s demographic characteristics as well as clinical features.However, the type of seizure precipitants was different in patients with different demographic and clinical characteristics.