Vagus nerve stimulation therapy improves quality of life in patients with intractable postencephalitic epilepsy, a study of five patients

@#Introduction: To evaluate the utility of vagus nerve stimulation (VNS) therapy for patients with intractable postencephalitic epilepsy in the reduction of seizure frequency and quality of life (QOL). Methods: We studied five patients with intractable postencephalitic epilepsy, the age ranged from 21 to 46 years. QOL of the patients was evaluated with the questionnaire, QOLIE-31-P. Results: VNS therapy improved seizure frequency in four patients (80%). One patient (20%) had no reduction of seizure frequency. Three patients had improvements in QOLIE-31-P (p < 0.024) and became socially independent. Two other patients continued to be dependent, and have lesser degree of improvements in their QOLIE-31-P scores.Conclusion: VNS is effective for patients with intractable postencephalitic epilepsy and is able to improve the QOL.

Comparison of Quality of Life in Patients With Epilepsy Taking Zonisamide or Topiramate: Before and After Treatment

BACKGROUND: Patients with epilepsy experience impairments in their quality of life (QOL). The objective of this study was to determine the influences of clinical factors on QOL and to compare QOL before and after antiepileptic drug (AED) treatment. METHODS: A cohort of 79 patients with epilepsy (43 male and 36 female) was recruited for this prospective study. The Quality of Life in Epilepsy (QOLIE)-31 survey was applied to evaluate QOL. The QOLIE-31 questionnaire was completed by the subjects before and 24 weeks after AED monotherapy (zonisamide or topiramate). The relationships of demographic, social, and clinical factors with QOL were evaluated. RESULTS: There was a negative correlation between seizure frequency and QOL in patients with epilepsy (p<0.05). The scores of patients without adverse effect were significantly higher for the seizure worry item of the QOLIE-31 questionnaire at 24 weeks compared to baseline (p<0.05). No other significant differences were found for any of the other QOLIE-31 items. CONCLUSIONS: Age, sex, seizure frequency, AED treatment, and AED adverse effects were significant clinical factors affecting QOL in patients with epilepsy. It is suggested that the physician should recognize these factors and manage them appropriately to improve the QOL of patients with epilepsy.

Qualidade de vida e desempenho ocupacional de pacientes submetidos à cirurgia de epilepsia / Quality of life and occupational performance of patients subjected to epilepsy surgery

OBJETIVO: este estudo teve como objetivo comparar a qualidade de vida e as áreas do desempenho ocupacional de pacientes epilépticos antes e doze meses após tratamento cirúrgico. METODOLOGIA: a amostra foi composta por 30 pacientes epilépticos que frequentavam o Centro de Cirurgia de Epilepsia da Faculdade de Medicina de São José do Rio Preto - FAMERP. Todos os participantes responderam a uma entrevista semiestruturada para coleta de dados sociodemográficos, ao Questionário de Qualidade de Vida em Epilepsia - 31 (QOLIE-31) e à Medida Canadense de Desempenho Ocupacional - MCDO. RESULTADOS: dezenove pacientes(63,3 por cento) eram do sexo feminino e onze (36,7 por cento) do sexo masculino, com idade entre 22 e 65 anos (42,1±11,9). Os resultados obtidos com o QOLIE-31 apontaram diferenças significativas em seis dos sete domínios que compõe o questionário quando comparados o período pré e pós-cirúrgico. A comparação dos resultados da COPM mostrou aumento significativo tanto na performance quanto na satisfação dos pacientes com suas atividades de vida diária, instrumentais de vida diária e de lazer. CONCLUSÃO: o tratamento cirúrgico se mostrou eficaz na melhora da qualidade de vida e no desempenho ocupacional o que pode traduzir-se a médio e longo prazo em integração social mais adequada para os pacientes epilépticos.

PURPOSE: this study aimed to compare the quality of life and areas of occupational performance in epileptic patients before and twelve months after surgery. METHODS: the sample consisted of 30 epileptic patients from the Centro de Cirurgia de Epilepsia da Faculdade de Medicina de São José do Rio Preto - FAMERP. All participants responded to a semi-structured interview to collect socio-demographic data, the Questionnaire Quality of Life in Epilepsy - 31 (QOLIE-31) and the Canadian Occupational Performance Measure - COPM. RESULTS: nineteen patients (63.3 percent) were female and eleven (36.7 percent) males, aged between 22 and 65 years (42.1±11.9). The results obtained with the QOLIE-31 showed significant differences in six of the seven areas that composed the questionnaire when compared to pre-and post-surgical period. The comparison of the results of COPM shows significant increase both in performance and in patients' satisfaction with their activities of daily living, instrumental in daily life and leisure. CONCLUSION: the surgical treatment is effective in improving the quality of life and occupational performance in what could be the medium and long-term social integration most appropriate for epileptic patients.

Epilepsia mioclônica juvenil: estudo clínico, epidemiológico, terapêutico e da qualidade de vida / Juvenile myoclonic epilepsy: a clinical, epidemiological, therapeutic and quality of life study

INTRODUÇÃO: A Epilepsia Mioclônica Juvenil (EMJ) é uma epilepsia idiopática generalizada, que, apesar de descrita há mais de um século, é uma entidade clínica ainda subdiagnosticada. OBJETIVO: Apresentar o perfil clínico, epidemiológico e terapêutico de pacientes com EMJ, além de mensurar a qualidade de vida destes. METODOLOGIA: Foram avaliados dezenove pacientes com EMJ, acompanhados no Hospital Universitário da Universidade Federal de Alagoas, com o Protocolo de Consulta Clínica e o QOLIE-31 (Quality of life in epilepsy), versão brasileira. RESULTADOS: O estudo mostrou que dentre os 19 pacientes selecionados, 12 (63 por cento) eram do sexo feminino; a idade de início das crises epiléticas teve média de 12 anos (±3); a história familiar para epilepsia foi positiva 78,9 por cento dos entrevistados; todos apresentavam crises mioclônicas de predomínio matinal associadas a crises tônico-clônicas generalizadas; 14 pacientes (73,7 por cento) estavam em monoterapia, sendo 13 com o ácido valpróico. A "Pontuação Global" (Overall score) do QOLIE-31 variou de 26 a 98, com média de 62,1 (±18,4) e T-score (escore padronizado) corresponde a 47. CONCLUSÃO: A análise dos resultados auxilia sobremaneira na melhor caracterização deste grupo de pacientes, além de quantificar através de instrumento validado, pela primeira vez, a qualidade de vida destes, a qual não pode mais ser ignorada no seu manejo.

INTRODUCTION: The Juvenile Myoclonic Epilepsy (JME) is an idiopathic generalized epilepsy that, despite being descripted for more than a century, it is still a clinical entity often misdiagnosed. OBJECTIVE: Introduce the clinical, epidemiological and therapeutic profile of patients with JME, addition to measuring the quality of their life. METHODOLOGY: Nineteen patients carrying JME were evaluated. They had been examinated at the Federal University of Alagoas' Academic Hospital, with the Clinical Enquiry Protocol and the QOLIE-31 (Quality of life in epilepsy), Brasilian version. RESULTS: Among the 19 selected patients, 63 percent were female; the average age for the first seizure was twelve years (±3); the epilepsy familiar history were positive in 78,9 percent of the patients; all patients presented myoclonic seizures with matinal predominance associated to generalized tonic-clonic seizures; 14 patients (73,7 percent) were in monotherapy, 13 of these with sodium valproate. The "Overall score" of QOLIE-31 range from 26 to 98, with an average score of 62,1 (±18,4) and T-score (standardized score) corresponding 47. CONCLUSION: The analysis helps considerably in the best characterization of this group of patients and quantifies for the first time, through validated instrument, the quality of life of them, which can no longer be ignored in their management.

Neuropsychological Assessment In Epilepsy Surgery – Preliminary Experience In A Rural Tertiary Care Hospital In North East Malaysia

We present our preliminary experience in neuropsychological testing in epilepsy surgery patients to demonstrate how these tests contributed to decide the laterality of epileptic focus, and to assess the effect of surgery on patient’s cognitive function and quality of life. Preoperative neuropsychological tests consisting of Wechsler Adult Intelligence Scale-III (WAIS) for IQ, Wechsler Memory Scale-III (WMS) for memory and patients’ quality of life (QOLIE 31) were administered to refractory epilepsy patients under evaluation for surgical treatment. These tests were repeated one year after surgery and we studied any changes in trends. A total of seven patients were recruited in this study between July 2004 and July 2006. The aetiologies of refractory epilepsy were pure mesial temporal sclerosis (MTS) in five patients, dysembryogenic neuroepithelial tumour (DNET) in one and dual lesion of cavernous angioma with ipsilateral MTS in one. The preoperative neuropsychological tests were all in concordance to MRI finding, and showed good contralateral function; five lateralises to the right and two to the left. The post-operative Engel seizure count (median 8.00, IQR 7.00–8.75), general IQ (88 vs. 79), performance IQ (94 vs. 79), verbal memory (89 vs. 71), non-verbal memory (88 vs. 75) and QOLIE (53.14 vs. 44.71) were better compared to preoperative values. The verbal IQ (84 vs. 84) was unchanged. Neuropsychological tests are useful as ancillary investigations to determine the laterality of seizure focus and integrity of function in the contralateral temporal lobe. Following successful surgical treatment, there is a trend towards improvement in memory, IQ and quality of life scores in this small group of patients.

Quality of life and the self-perception impact of epilepsy in three different epilepsy types

PURPOSE: This study aimed to evaluate the quality of life (QOL) and verify the domains of greater impact in patients with focal and generalized epilepsies. METHODS: The sample, composed by 57 subjects from Hospital São Paulo da Universidade Federal de São Paulo, was divided into 3 groups, temporal lobe epilepsies (TLE), extra-temporal epilepsies (Extra-TLE) and idiopathic generalized epilepsy (IGE). They answered a preliminary self-reported questionnaire to identify the perception of the most impaired aspects in their lives. The QOL was evaluated through the validated Brazilian version of the Quality of Life Epilepsy Inventory 31 (QOLIE-31). The correlation of the QOLIE-31 domains with epilepsy duration and seizure frequency was defined by dispersion graphics and also Pearson’s and Spearman’s correlation. RESULTS: The most frequently identified impact of epilepsy was related to interpersonal, familial and social relationships mentioned by 13 (22.81 percent) patients. The seizure frequency per patient in Extra-TLE group was significantly greater (p = 0.007) than in the other groups. The Cognition Functioning scores were lower for the Extra-TLE group (38.4) when compared with TLE (52.6) and IGE (62.6) (p = 0.01). The correlation between epilepsy duration and QOLIE-31 domains did not demonstrate statistical significance; however, seizure frequency was correlated with Seizures Worry (p = 0.0463, alpha = 0.05) and Medication Effects (p = 0.0476, alpha = 0.05) domains. CONCLUSIONS: 1) Interpersonal, familial, and social relationships were the dimension which most impacted daily life; 2) Cognition domain in Extra-TLE group showed the worst scores; 3) QOL scores were similar in the three groups for the majority of the QOLIE-31 domains; 4) The seizure frequency in the Extra-TLE group was significantly greater; 5) Seizure frequency was associated with worse QOLIE-31 scores in the domains Seizure Worry and Medication Effects.

OBJETIVO: Este estudo teve como objetivo avaliar a qualidade de vida (QV) em três diferentes grupos de epilepsia e verificar a esfera percebida como de maior impacto na vida diária. METODOLOGIA: A amostra foi composta por 57 pacientes com epilepsias focais e generalizadas do Hospital São Paulo, Universidade Federal de São Paulo, divididos em três grupos, epilepsias do lobo temporal (ELT), extratemporais (Extra-ELT) e generalizadas idiopáticas (EGI). Os pacientes responderam a um questionário preliminar para identificar a percepção sobre os aspectos mais comprometidos em suas vidas. A QV foi avaliada por meio da versão brasileira do Quality of Life in Epilepsy Inventory 31 (QOLIE-31). A correlação dos domínios do QOLIE-31 com a duração da epilepsia e freqüência de crises foi definida pela inspeção dos gráficos de dispersão e pela correlação de Pearson e de Spearman. Foram considerados significantes os valores de p < 0,05. RESULTADOS: Dificuldades nas relações interpessoais, familiares e sociais foram apontadas como a esfera de maior impacto relacionado à epilepsia, citada por 13 (22,81 por cento) pacientes. O QOLIE-31 mostrou resultado semelhante nos três diferentes tipos de epilepsia, com exceção do domínio Funcionamento Cognitivo. Os escores deste domínio foram significativamente menores (p = 0,01) no grupo com Extra-ELT (38,4) do que nos grupos ELT (52,6) e EGI (62,6). A duração da epilepsia não influenciou na QOL nesta amostra, porém foi observada uma correlação estatística significante entre a freqüência de crises e os domínios Efeitos da Medicação (p = 0,0476, alfa = 0,05) e Preocupação com Crises (p = 0,0463, alfa = 0,05). A freqüência de crises mostrou ainda uma diferença estatisticamente significante (p = 0.007) no grupo com Extra-ELT, que apresentou mais crises/paciente, quando comparado aos demais grupos. CONCLUSÕES: Os pacientes identificaram as relações interpessoais, familiares e sociais como sendo a área mais afetada pela...

Low education, more frequent of seizure, more types of therapy, and generalized seizure type decreased quality of life among epileptic patients.

Persons with chronic disease such as epilepsy, where a cure is not attainable and therapy may be prolonged, quality of life (QoL) has come to be seen as an important goal. The objective of this study was to identify scores of quality of life (QoL related to clinical factors. A cross-sectional study using QOLIE-31 instrument to identify quality of life among ambulatory epileptic patients at Epileptic Clinic of Department of Neurology-Cipto Mangunkusumo Hospital. Samples were taken consecutively from August 2005 to December 2005. Several demographic data as well as clinical were collected. QOLIE-31 components consisted of seizure worry, overall quality of life, emotional well-being, energy/fatigue, cognitive function, medication effect and social function. We found among 145 subjects the total score of QOLIE-31 ranged from 28-95 (mean = 67.6; standard of deviation = 14.55). The total score of QOLIE-31was corelated with low education, more frequent of seizures, antiepileptic drug politherapy and type of generalized seizure. antiepileptic drug politherapy was the most dominant risk factor for lowering total score of QOLIE-31. Our finding was in accordance with previous studies in India, Georgia, South Korea. In additioin we found that education was also a risk factor for total score of QOLIE-31.

Reliability and Validity of the Korean Version of QOLIE-10 in Epilepsy

BACKGROUND AND PURPOSE: It is necessary in clinical practice to screen patients with epilepsy for quality-of-life factors. The purpose of this study was to develop a Korean version of the Quality of Life in Epilepsy (QOLIE)-10 survey and to determine its reliability and validity. METHODS: Data were collected from 397 adult epilepsy patients. The ten items of QOLIE-10 were derived from the Korean version of QOLIE-31. We assessed factor analysis, internal consistency, test-retest reliabilities, construct validity, and discriminant validity. Test-retest was performed in 97 patients. RESULTS: The ten items of QOLIE-10 were grouped into two factors: epilepsy effects/role function (driving, social, work, physical effect, mental effect, and memory) and mental health (overall quality of life, depression, and energy). The internal consistency reliability coefficient (Cronbach's alpha) was 0.843 for epilepsy effects/role function and 0.606 for the mental-health scale. Test - retest data revealed statistically significant correlations for individual items (range, r=0.66-0.38) and scales (range, r=0.63-0.48), except for one item, driving (r=0.21, p=0.133). QOLIE-10 was significantly correlated with the source scales in the Korean version of QOLIE-31 and with several external measures. The QOLIE-10 scores discriminated between patient groups according to their seizure severity and level of education. CONCLUSIONS: QOLIE-10 was derived from the Korean version of QOLIE-31. The results of this study show that QOLIE-10 can be applied as a screening measure of quality of life in Korean epilepsy patients.

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 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.