Natural course and predictors of spontaneous seizure remission in idiopathic generalized epilepsy: 7-27 years of follow-up.

The spontaneous course of idiopathic generalized epilepsy (IGE) is still controversial. The aim of this study was both to investigate the long-term spontaneous course and to identify factors that are predictive for epilepsy remission in a small cohort of 15 IGE patients (9 women) who refused antiepileptic drug (AED) treatment and therefore never have been treated with AED. All of them were reevaluated with a review of their medical records and direct face-to-face interview; the mean duration of follow-up was 15.3 years. Five (33.3%) of them had absence epilepsy (absence seizures, ABS), 5 had IGE with generalized tonic-clonic seizures (GTCS), and another 5 had both seizure types (IGE with ABS/GTCS). Rate of epilepsy remission was 53.3% with a mean time of seizure freedom of 13.1 years; rate of remission was highest among absence epilepsy patients (80%), followed by IGE with GTCS (60%) and IGE with ABS/GTCS (20%). The frequency of spontaneous generalized interictal epileptiform discharges in electroencephalography is not associated with the long-term seizure outcome (p=0.201) and per se does not require AED treatment. Furthermore, the occurrence of photoparoxysmal responses (p=0.020) as well as the occurrence of more than 3 GTCS during the course (p=0.029) were identified as significant predictors for a poor long-term seizure outcome which makes AED treatment indispensable in these patients. This study underlines the heterogenity of the group of IGE. AED treatment has no impact on the spontaneous course of IGE with ABS and/or GTCS. Several predictors for the long-term seizure outcome in patients with IGE were identified in this study.

Dimensions and profiles of the generalized health-related self-concept.

OBJECTIVES: We explore the significance of health as a potentially self-relevant category from the perspective of dynamic self-concept theory. Our intention was to describe the dimensional structure of the generalized health-related self-concept, to identify particular prototypes of health-related self-definition, and to see if these prototypes would differ with respect to appraisals of health behaviour and subjective health. DESIGN: We conducted a cross-sectional questionnaire study involving 545 college students (23.3% male) at the mean age of 22 years. METHODS: The self-administered questionnaire assessed a relevant spectrum of health-related cognitions denoting their generalized declarative knowledge about their health (the generalized health-related self-concept). Additionally, participants rated their multiple health behaviour, their perceived health, and their anticipated vulnerability. RESULTS: A principal components analysis of the health-related cognitions revealed the following five dimensions: health-protective dispositions, health-protective motivation, vulnerability, health-risky habits, and external, avoidant motivation. A two-step cluster analysis of the five components identified six profiles of health-related self-concept: careless/carefree, omnipotents, risk-takers, mentally affected, reluctant-avoidant, and medically fragile. These prototypes could be successfully reclassified (97.6%). The six profiles differed with respect to their health behaviour and subjective health appraisals. CONCLUSIONS: The dimensional structure represents both resources and deficits with respect to an individual's health-related self-concept. An individual's profile of these dimensions might correspond to a characteristic set of particular health needs and motivations. Successful health communications should follow a complementary strategy of affirming the self-concept.

Effects of a step-by-step inpatient rehabilitation programme on quality of life in breast cancer patients. A prospective randomised study.

BACKGROUND: The aim of this study was to compare a conventional oncological inpatient rehabilitation programme with an inpatient step-by-step rehabilitation programme with regard to quality of life in breast cancer patients. PATIENTS AND METHODS: Women with the diagnosis of breast cancer were randomly assigned to either the step-by-step programme (group A: 3-week rehabilitation plus 4 and 8 months later a 1-week sojourn each time) or the conventional rehabilitation programme (group B: 4- week stay and no further interventions afterwards). Quality of life was assessed with the QLQ-C30 of the EORTC at t0 (beginning of the study), t1 (end of 3- or 4-week stay) and t2 (12 months after t0, end of study). RESULTS: Between t0 and t1, a tendency (0.1 > p = 0.05) could be shown in group B towards better improvement in global quality of life and emotional function. In the subgroup of patients that had impaired functions of quality of life at t0, superiority in group B reached significance (p < 0.05) for emotional and cognitive function at t1. Between t1 and t2, cognitive function improved further in group A, but diminished in group B. For the subgroup of patients with impaired cognitive function at t0, this difference between both groups became significant (p = 0.0098). CONCLUSIONS: Although not generally superior to conventional inpatient rehabilitation programmes, the analysed step-by- step rehabilitation provided marked benefits for patients with cognitive impairments.

[Improvement of health-related quality of life in breast cancer patients by inpatient rehabilitation]. / Verbesserung der gesundheitsbezogenen Lebensqualität bei Brustkrebspatientinnen durch stationäre Rehabilitation.

PURPOSE: Improvement of health-related quality of life in women with breast cancer after primary therapy by standardized inpatient rehabilitation. PATIENTS AND METHODS: 129 women with breast cancer, 25-75 years old, and 42 healthy women were interviewed about their health-related quality of life by using the EORTC-QLQ-C30. This questionnaire assesses different aspects of quality of life as well as overall quality of life. Quality of life of breast cancer patients was assessed before and after inpatient rehabilitation, considering especially their age and the interval between diagnosis and rehabilitation. RESULTS: Compared with healthy women, the breast cancer patients had distinctly reduced values in the beginning of rehabilitation. By specific therapy, the overall quality of life as well as physical, emotional and role function could be improved significantly (p < 0.0001). Concerning cognitive and social function, there were also significant changes after rehabilitation (p < 0.0001), but only in 50% of the women an improvement could be shown. There was no evidence of correlation between quality of life after the end of primary therapy and the patients' age or the interval between diagnosis and rehabilitation. CONCLUSION: Up to 3 years after the end of primary therapy, the health-related quality of life is noticeably reduced in breast cancer patients, without showing a tendency toward spontaneous improvement. By an intensive therapy with psychooncologic measures and activating physiotherapy, the quality of life can be improved in these patients. Whether this improvement leads to a long-term effect must be shown by a presently conducted randomized, prospective study.