ABSTRACT
PURPOSE: It is believed that a large number of factors influence feelings of stigma, but their relative contribution is not yet entirely clear. Most studies to date were conducted using the Epilepsy Stigma Scale (ESS); only one used a revised version of the ESS (rESS). The following study aims to determine factors contributing to epilepsy stigma in outpatients with chronic epilepsy in Croatia, and to analyze some psychometric properties of the Croatian translation of the rESS. METHODS: Alongside standard testing for validity of the scale, a simulation model of the original ESS (smESS) was created. This model, which does not include a grading Likert 0-3 scale, was compared with the rESS. RESULTS: In total, 159 out of 298 subjects (53%) reported feeling stigmatised, with 136 (45%) mild to moderately and 23 (8%) highly. Internal consistency of the Croatian translation of the rESS was 0.887. Feelings of stigma were significantly associated with age ≤ 50 years, younger age of epilepsy onset, more than 50 seizures to date, generalized tonic-clonic seizures, and a shorter seizure-free period. Multiple stepwise regression showed number of seizures to date as a significant variable (Beta=0.246). By adapting data into the smESS significant associations with younger age and age of epilepsy onset were lost. Internal consistency of the smESS was 0.849. CONCLUSIONS: The Croatian translation of the rESS has been proved to be a suitable instrument for diagnosing epilepsy stigma. The results of our model point to the possibility that the rESS might be more sensitive than the original ESS.
Subject(s)
Epilepsy/psychology , Social Stigma , Surveys and Questionnaires , Adolescent , Adult , Age Factors , Age of Onset , Aged , Aged, 80 and over , Computer Simulation , Croatia , Female , Humans , Male , Middle Aged , Models, Psychological , Outpatients/psychology , Psychometrics , Seizures/psychology , Stereotyping , Young AdultABSTRACT
Central poststroke pain is a type of neuropathic pain which is caused by damage to the central nervous system after a stroke and which is localized to the territory of the neurological deficit which corresponds to the cerebrovascular lesion. Stroke is the commonest cause of central neuropathic pain. The purpose of this paper is to draw attention to the importance of this disorder and briefly summarize some clinical aspects and proposed pathophysiological mechanisms on which the rational therapy is based. Due to the lack of randomized controlled trials about the efficacy of the pharmacological treatment, therapeutic guidelines are based also on clinical experience, uncontrolled studies and experts' opinion. According to international guidelines for the treatment of central poststroke pain, the first line therapy is tricyclic antidepressants (amytriptilin and nortriptilin) or antiepileptic drugs (lamotrigine, gabapentine, pregabaline, carbamazepine). The second line is tramadol, opioids and fluvoxamin.
