Comorbid Neurocognitive Impairment in Patients with Epilepsy

Background: Epilepsy is a common chronic non-communicable neurological disorder in which the brain function is impaired. Cognitive function is more frequently impaired in people with epilepsy than in the general population. The neurocognitive outcome of epilepsy in children and adults is vital for social prognosis and quality of life assessment. Cognitive changes in epilepsy have multifactorial etiology, including the epilepsy itself, age at onset, duration of epilepsy, treatment of epilepsy, reaction to epilepsy and any associated brain dysfunction and /or damage. This study was conducted to check association of neurocognitive impairment with the socio-demographic factors and disease associated factors in patients with epilepsy. Methodology: This study was a single centre cross-sectional study in which 96 patients were included. Severity of neurocognitive impairment was measured by Addenbrookes’ Cognitive Examination- R (ACE- R) score. Results: Out of 96 patients, neurocognitive impairment was seen in 23 (23.95%) patients. Conclusions: This study shows that neurocognitive impairment was found to be more when the age at onset of epilepsy was less, when the duration of the illness was more and when frequency of seizure was higher. Conclusion: Neurocognitive impairment is noted in patients with epilepsy and must be treated in the long- term management of epilepsy

Current norms and practices in using a seizure diary for managing epilepsy: A scoping review

Epilepsy is a chronic and debilitating condition affecting people of all ages in many nations. Healthcare practitioners look for effective ways to track patients' seizures, and a seizure diary is one of the methods used. This scoping review sought to identify current norms and practices for using seizure diaries to manage epilepsy. Method: A scoping review was performed by screening relevant studies and identifying themes, categories and subcategories. Results: A total of 1125 articles were identified from the database; 46 full-text articles were assessed for eligibility, of which 23 articles were selected. The majority (48%) of the studies were prospective studies. The majority (65%) of the articles were studies conducted in the United States. The themes identified were types of seizure diaries used in clinical practice, contents and structure of a standardized seizure diary, the use and efficacy of seizure diaries in medicine and challenges relating to using a seizure diary for patient management. Conclusion: The study revealed that a seizure diary remains a relevant tool in managing epilepsy. The two forms of diaries in use are electronic and paper-based diaries. The high cost of data and the expensive devices required to access electronic diaries make it unsuitable in a resource-limited setting. Despite its disadvantages, imperfections and inadequacies, the paper-based diary is still relevant for managing patients with epilepsy in resource-limited settings. Contribution: This study reviewed the literature to find the current norms and practices in using seizure diaries. The benefits of the different formats were emphasized

Demographic and Clinical Correlates of Seizure Frequency: Findings from the Managing Epilepsy Well Network Database

BACKGROUND AND PURPOSE: Epilepsy is a chronic neurological disease that represents a tremendous burden on both patients and society in general. Studies have addressed how demographic variables, socioeconomic variables, and psychological comorbidity are related to the quality of life (QOL) of people with epilepsy (PWE). However, there has been less focus on how these factors may differ between patients who exhibit varying degrees of seizure control. This study utilized data from the Managing Epilepsy Well (MEW) Network of the Centers for Disease Control and Prevention with the aim of elucidating differences in demographic variables, depression, and QOL between adult PWE. METHODS: Demographic variables, depression, and QOL were compared between PWE who experience clinically relevant differences in seizure occurrence. RESULTS: Gender, ethnicity, race, education, income, and relationship status did not differ significantly between the seizure-frequency categories (p>0.05). People with worse seizure control were significantly younger (p=0.039), more depressed (as assessed using the Patient Health Questionnaire) (p=0.036), and had lower QOL (as determined using the 10-item Quality of Life in Epilepsy for Adults scale) (p < 0.001). CONCLUSIONS: The present results underscore the importance of early screening, detection, and treatment of depression, since these factors relate to both seizure occurrence and QOL in PWE.

In adolescents with epilepsy, high scores of anxiety and depression are associated with occurrence of seizures in public places / Em adolescentes com epilepsia, altos escores de ansiedade e depressão foram associados com ocorrência de crises em lugares públicos

Objective To assess depression and anxiety symptoms of adolescents with epilepsy compared with adolescents without epilepsy. Method The study sample consisted of: case participants (50 subjects) attending the pediatric epilepsy clinic of a tertiary hospital and control participants (51 subjects) from public schools. The instruments utilized were: identification card with demographic and epilepsy data, Beck Depression Inventory and State-Trait Anxiety Inventory. Results No significant differences were founded between the groups regarding scores for depression and anxiety symptoms but both groups presented moderate scores of anxiety. A correlation was found between low scores anxiety and not frequent seizures, low scores anxiety and perception of seizure control, high scores of anxiety and depression and occurrence of seizures in public places. Conclusion Low scores of anxiety are associated with not frequent seizures; high scores of anxiety and depression are associated with occurrence of seizures in public places. .

Objetivo O presente estudo teve como objetivo avaliar os sintomas de ansiedade e depressão de adolescentes com epilepsia comparados com adolescentes sem epilepsia. Método A amostra consistiu: grupo caso (50 indivíduos) atendidos no ambulatório de epilepsia infantil do Hospital Universitário e grupo controle (51 indivíduos) de escolas públicas. Os instrumentos utilizados foram: cartão com dados demográficos e de epilepsia, Beck Depression Inventory e State-Trait Anxiety Inventory. Resultados Os resultados não mostraram diferenças significativas entre os grupos em relação à depressão e ansiedade, mas ambos os grupos apresentaram escores moderados de ansiedade. Foi encontrada correlação entre baixa pontuação de ansiedade e crises não frequentes e percepção de controle de crises; altas pontuações de ansiedade e depressão e ocorrência de crises em lugares públicos. Conclusão Variáveis psicossociais e da doença são contingências importantes no comportamento adaptativo e controle do humor em uma doença crônica como a epilepsia. .

Clinical Observation of Carbamazepine Combined with Topiramate in the Treatment of Partial Epilepsy / 中国药房

OBJECTIVE:To observe the efficacy and safety of carbamazepine combined with topiramate in the treatment of par-tial epilepsy. METHODS:130 patients with partial epilepsy were randomly divided into observation group and control group. Con-trol group was orally treaed with carbamazepine 100 mg,3 times a day. Based on the treatment of control group,observation group was orally treaed with topiramate initial dose of 25 mg,once a day,and then increased 25 mg every week,the maximum dose was no more than 200 mg,once a day. After 6 months,the efficacy was evaluated,frequency of epileptic seizures,EEG epileptiform discharges wave and incidence of adverse reactions were observed. RESULTS:The total effective rate in observation group was sig-nificantly higher than control group(P0.05). CONCLUSIONS:Carbamazepine combined with topiramate has better efficacy than carbamazepine alone in the treatment of partial epilepsy,with similar safety.

Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency? / Morte súbita em crianças com epilepsia ocorre naquelas que apresentam maior frequência de crises?

People with epilepsy are more likely to die prematurely and the most common epilepsy-related category of death is sudden unexpected death in epilepsy (SUDEP). Several studies have reported a moderate or high seizure frequency among SUDEP cases and SUDEP is considered rare in patients in remission. METHOD: We reviewed the occurrence of SUDEP in our epilepsy unit over an 8-year period to identify a potential association between seizure frequency and SUDEP occurrence in children with epilepsy. RESULTS: From 835 patients evaluated, 12 had suffered SUDEP and nearly all of the SUDEP cases in our children are related to chronic uncontrolled epilepsy (daily - 50.0 percent, two to four/week - 41.7 percent, monthly - 8.3 percent). CONCLUSION: SUDEP is not a rare event in children and increased mortality was recorded in those individuals who had not responded to pharmacologic treatment. Improved seizure control seems to be one of the most important measures to prevent SUDEP.

Pessoas com epilepsia têm maior chance de morrer prematuramente e a principal causa de morte relacionada à epilepsia é a morte súbita em epilepsia (SUDEP). Vários estudos têm relatado uma freqüência de crises moderada ou elevada em pacientes com SUDEP e SUDEP é considerada rara em pacientes em remissão. MÉTODO: Revisamos a ocorrência de SUDEP em nossa unidade de epilepsia por um período de oito anos com o objetivo de identificar uma possível associação entre freqüência de crises e a ocorrência de SUDEP em crianças com epilepsia. RESULTADOS: De 835 pacientes avaliados, 12 evoluíram com SUDEP e a maioria das crianças apresentava epilepsia crônica não controlada (50 por cento com crises diárias; 41,7 por cento com duas a quatro crises/semana; 8,3 por cento com crises mensais). CONCLUSÃO: SUDEP não é um evento raro em crianças e maior mortalidade foi observada em indivíduos que não responderam ao tratamento medicamentoso. Melhor controle de crises parece ser uma das principais medidas na prevenção de SUDEP.

The effects of epileptic seizures upon quality of life / Efeito das crises epilépticas na qualidade de vida

OBJECTIVE: understand the psychological considerations of the relationship between the effect of seizures upon the patients' perception of seizure control, depression, anxiety and quality of life (QoL). METHODS: 151 adult patients with epilepsy diagnosed for over two years were interviewed and responded the 31-Item Quality of Life in Epilepsy (QOLIE-31), the Trait Form of the State/Trait Anxiety Inventory (STAI II) and the Beck Depression Inventory (BDI). RESULTS: 45 patients were depressed (29.8 percent) and 29 (19.2 percent) had anxiety. Depression scores ranged from 0 to 49 (M=7.4; SD=8.9) and anxiety scores ranged from 19 to 69 (M=41.5, SD=11.9). Total QoL score was correlated to seizure control (p<0.001), perception of epilepsy control (p<0.001), anxiety (p<0.001), and depression (p=0.003). The perception of epilepsy control was correlated to seizure control (p<0.001), seizure frequency (p=0.001), anxiety (p<0.001) and depression (p<0.001). Seizure control was associated to anxiety (p=0.033) and depression (p<0.001). There was co-morbidity between anxiety and depression (p<0.001). CONCLUSION: This study highlights the importance of the seizure frequency and control to the evaluation of perception of epilepsy control and shows that anxiety and depression in epilepsy are predicted by seizure-related (seizure frequency and control) and psychosocial aspects (perception of control and QoL) together.

OBJETIVO: Explicarmos a relação entre o efeito das crises epilépticas na percepção subjetiva de controle do paciente, e nos sintomas de depressão, ansiedade e qualidade de vida (QV). MÉTODOS: 151 adultos com epilepsia foram entrevistados e responderam o questionário de qualidade de vida (QOLIE-31), o STAI-II (Traço de Ansiedade) e o inventário de depressão de Beck (BDI). RESULTADOS: 45 pacientes (29.8 por cento) apresentaram sintomas de depressão e 29 (19.2 por cento), traço de ansiedade. O escore de depressão variou de 0 a 49 (M=7.4; SD=8.9) e o de ansiedade de 19 a 69 (M=41.5, SD=11.9).O escore total de QV foi associado ao controle de crises (p<0.001), percepção de controle da epilepsia (p<0.001), ansiedade (p<0.001) e depressão (p=0.003). A percepção de controle foi associada ao real controle de crises (p<0.001), frequência de crises (p<0.001), ansiedade (p<0.001) e depressão (p<0.001). O controle de crises foi associado à ansiedade (p=0.033) e depressão (p<0.001). Ansiedade e depressão foram correlacionadas (p<0.001). CONCLUSÃO: Este estudo aponta a importância da redução da frequência de crises, assim como o seu controle, na avaliação da percepção de controle da epilepsia e mostra que ansiedade e depressão são resultado de fatores associados ao controle à frequência de crises, assim como à percepção de controle e à QV.

Factors Influencing on Fatigue in Patients with Epilepsy / 대한간질학회지

PURPOSE: Fatigue is defined as a tired feeling, lack of energy, or feeling of exhaustion. Antiepileptic drugs, seizure and frequent interictal epileptiform activity can cause fatigue in epilepsy patients. The aim of this study is to determine the rate of fatigue and to assess the influence of clinical and demographic factors on fatigue in patients with epilepsy. METHODS: Fatigue was evaluated in 39 epilepsy patients by using Fatigue Severity Scale (FSS). Multiple regression analysis was performed to assess the influence of different factors on fatigue. RESULTS: In patients with epilepsy the mean score of FSS was 4.54+/-1.69, and the rate of fatigue was 66.7%. Among these patients, 23.1% had medium fatigue, and 43.6% had serious fatigue. The variable that strongly predicted a high FSS mean score was high seizure frequency. Conclusion: Fatigue is very common, and seizure frequency is an important factor influencing on fatigue in epilepsy patients.

Effect of Multiple Interventions on Therapy Efficacy to the Patients with Epilepsy / 中国康复理论与实践

@#Objective To observe the effect of multiple interventions on secondary epilepsy patients.Methods 114 secondary epilepsy patients were randomly divided into the intervention group and control group with 57 cases in each group.The cases in the intervention group received multiple interventions including heath education,psychological treatment,safety nursing,overdose administration,early rehabilitation,discharge guide and so on besides usual nursing.While,the cases in the control group received usual nursing.The follow-up was performed for 6 months and the therapeutic efficacy of two groups was compared.Results After multiple interventions,the seizure frequency and trauma incidence rate decreased,compliance and quality of life increased in patients of the intervention group,and there was a significant difference compared with the control group(P<0.05).Conclusion Multiple interventions can decrease seizure frequency and increase compliance of treatment and quality of life of secondary epilepsy patients.

Clinical Experiences with Vagus Nerve Stimulation for Medically Intractable Epilepsy / 대한간질학회지

PURPOSE: Recently, Vagus nerve stimulation (VNS) has been reported to show promising results as an adjunctive therapy for medically intractable seizures. We report early experiences with VNS for medically intractable epilepsy in young adults and pediatric patients. METHODS: Eleven patients ages ranging from 7 years to 29 years underwent implantation of vagal nerve stimulators (Cyberonics, Houston, TX) from September 1999 to April 2003. We reviewed clinical findings in 11 patients and recorded changes of seizure frequency, quality of life (QOL), and antiepileptic drug (AED). RESULTS: The mean age of seizure onset was 4.5 years old (range:3 months-11 years). The seizure duration before VNS was mean 8.7 years (range:1.5-19 years). Seven patients had symptomatic partial epilepsies, and one had cryptogenic partial epilepsy. Unclassified patients had 2 Lennox-Gastaut syndrome and 1 reflex epilepsy. Two patients received total callosotomy for reducing drop attack, but refractory. One patient, who underwent a temporal lobectomy, failed to obtain desirable results. One implantation was performed with total callosotomy, simultaneously. All of implantations were successful, except for one wound revision due to a subcutaneously protruded anchoring device of electrode. About two weeks after the implantation, programming of the stimuli was started and increased the output current to the levels, at which patients was tolerated. The most common adverse effect was hoarseness or voice alteration (44%). Mean reduction of seizure frequency compared with baseline before VNS was 23.6% after 3 months, 33.5% after 6 months, 41.3% after 1 year, and 46.6% at latest follow-up. Three patients had no response to VNS. One patient was added 1 one new AED after VNS. Two patients were reduced 1 or 2 drugs. But there was no correlation between VNS effect and AED change. Six patients had some improvement of QOL. Mean follow-up period, which was 28 months (range:12-48 months). CONCLUSIONS: We concluded that VNS has a role of adjunctive therapy for medically intractable epilepsy and the further studies should be focused on the prediction of unresponsiveness and the adjustment of VNS parameters for maximal efficacy in patients with various backgrounds.