Anxiety disorders in predominantly African American and Caribbean American adults with intractable epilepsy: The role of perceived epilepsy stigma.

INTRODUCTION: Anxiety disproportionately affects people with epilepsy (PWE) and leads to poor outcomes. Yet, risk factors are not well understood especially among underserved groups. This cross-sectional study aimed to identify epilepsy-specific predictors of anxiety disorders in predominantly African American and Caribbean American PWE. MATERIALS AND METHODS: The prevalence of anxiety disorders was established via diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)). We identified the extent to which aspects of seizure burden (seizure frequency, seizure severity, convulsive vs. nonconvulsive seizures), seizure worry, and perceived epilepsy stigma were associated with anxiety disorder diagnosis. Finally, logistic regression assessed the overall and independent contributions of significant risk factors. RESULTS: There were 60 participants (62% women, 52% African American, 27% Caribbean American, 20% Hispanic/Latino) with an average of 2 seizures per month. Nearly half of the sample (43%) had ≥1 anxiety disorder, with 62% of affected individuals qualifying for agoraphobia. Those with anxiety disorders tended to have convulsive seizures (p = 0.037) and endorsed greater seizure worry (p = 0.012), more general symptoms of anxiety (p = 0.005), and worse perceived epilepsy stigma (p = 0.003). Logistic regression accounted for 28% to 37.6% of the variance in anxiety disorder diagnostic status and correctly classified 73% of cases; however, only perceived epilepsy stigma made a unique contribution. CONCLUSIONS: Anxiety disorders were prevalent in these predominantly African American and Caribbean American PWE. Epilepsy-specific risk factors included convulsive seizures, seizure worry, and perceived epilepsy stigma. Interventions aimed at treating anxiety disorders in diverse PWE may especially benefit from targeting stigma beliefs.

Accounting for ethnic-cultural and linguistic diversity in neuropsychological assessment of patients with drug-resistant epilepsy: A retrospective study.

Neuropsychological assessment is critical in both diagnosis and prognosis of patients with epilepsy. Beyond electrophysiological and anatomical alterations, other factors including different ethnic-cultural and linguistic backgrounds might affect neuropsychological performance. Only a few studies considered migration and acculturation effects and they typically concerned nonclinical samples. The current study aimed at investigating the influence of ethnic background and time spent in Italy on a full neuropsychological battery administered to both Italian and foreign-born patients and at providing a brief interview for obtaining relevant information on each patient's transcultural and language-related history. Clinical reports from 43 foreign-born patients with drug-resistant epilepsy were collected from the archives of Milan Niguarda Hospital. Epileptogenic zone, age, education, profession, illness duration, seizure frequency, handedness, and gender were considered in selecting 43 Italian controls. Ethnicity (Italian/foreign-born) and years spent in Italy were analyzed as main predictors on 21 neuropsychological scales by means of General(ized) Linear Models. An additional analysis studied two composite scores of overall verbal and nonverbal abilities. Ethnicity significantly affected the following: the verbal overall score, Verbal Fluency, Naming, Token-test, Digit Span, Attentional Matrices, Trail-Making-Test, Line-Orientation-Test, and Raven matrices; no effects were found on the nonverbal overall score, Word Pairs Learning, Episodic Memory, reading accuracy, visual span, Bells test, Rey Figure, and face memory and recognition. No significant effects of years spent in Italy emerged. While years spent in Italy does not predict neuropsychological performance, linguistic background had a strong impact on it. With respect to Italian-speaking patients, those who were foreign-born showed large task-related variability, with an especially low performance on language-related tests. Hence, language tests should not be considered as valid measures of neuropsychological impairment in this population, not even in foreign-born patients with good Italian fluency. Clinicians should consider such asymmetries in order to improve the accuracy of neuropsychological assessment of foreign-born patients.

Association study between polymorphisms in the CACNA1A, CACNA1C, and CACNA1H genes and drug-resistant epilepsy in the Chinese Han population.

PURPOSE: As important ion channels of the central nervous system, calcium channels not only take part in epileptogenesis but also act as the targets of commonly used antiepileptic drugs (AEDs). Thus, this study aimed to provide the first investigation of the association between CACNA1A, CACNA1C, and CACNA1H single nucleotide polymorphisms (SNPs) and AED resistance in the Chinese Han population. METHODS: We performed genotyping of tagging single nucleotide polymorphisms (tagSNPs) of CACNA1A, 1C and 1H in 480 Chinese epilepsy patients (288 drug-responsive and 192 drug-resistant patients). The Illumina GoldenGate BeadArray assay was used to detect the genotypes of all of the patients. A total of 15 SNPs were selected based on the HapMap database. The genotype distributions in drug-responsive and drug-resistant patients were compared, and the haplotype frequencies of each gene were calculated. RESULTS: None of the 15 tagSNPs alleles were found to be associated with drug-resistant epilepsy. However, the frequency of the TAGAA haplotype in CACNA1A was significantly higher in drug-resistant patients than in drug-responsive patients after the correction of multiple comparisons with Bonferroni's method (TAGAA 13.3% vs. 7.1%, OR=2.129 [1.373-3.299], P=0.00059<0.05/10). CONCLUSIONS: This study revealed no association between the 15 tagSNPs of CACNA1A, 1C, and 1H and drug efficacy in the Chinese Han population. The TAGAA haplotype of CACNA1A may be a risk factor for AED resistance.

ABCB1 G2677T/A polymorphism is associated with the risk of drug-resistant epilepsy in Asians.

Pharmacogenetic factors may play an important role in drug-resistant epilepsy. The association between the non-synonymous polymorphism G2677T/A in the coding region of the ABCB1 gene, and the risk of resistance to anti-epileptic drugs (AEDs) in epilepsy remains controversial. The present study used a meta-analysis approach to assess the pooled association between this polymorphism and the risk of resistance to AEDs. We used several online libraries to identify suitable studies published before September 2014, and 15 studies (n=1773 drug-resistant, and n=2250 drug-responsive epilepsy cases) were selected for our analysis. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association. Subgroup analysis was performed taking into account different ethnic groups. Our results suggest that ethnicity plays a role in the association between ABCB1 G2677T/A polymorphism and drug-resistant epilepsy. We found a significant association for Asians both under the codominant model TT vs. GG (OR=1.33, 95% CI: 1.05-1.69; P=0.019), and the allele model T vs. G (OR=1.13, 95% CI: 1.01-1.27; P=0.032). However, no association was observed for Caucasians in either the TT vs. GG (OR=0.85, 95% CI: 0.61-1.18; P=0.335), or the T vs. G (OR=0.93, 95% CI: 0.78-1.09; P=0.362) models. A cumulative meta-analysis showed that these results were robust. In conclusion, our analysis indicates that ABCB1 G2677T/A polymorphism may increase the risk of drug-resistant epilepsy in Asians.