Therapy delay in status epilepticus extends its duration and worsens its prognosis.

BACKGROUND: Timing in status epilepticus (SE) attention is probably the most relevant modifiable prognostic factor and may influence SE duration and prognosis. We aimed to describe the precise relationship between management timing, duration, and prognosis of SE. METHODS: Observational longitudinal prospective study on a cohort of all patients diagnosed with SE admitted to our tertiary hospital from September 2017 to August 2019, with a 3-month follow-up. Univariate and multivariable analyses were performed to identify clinical and timing variables associated with SE duration and prognosis. RESULTS: Eighty-three SE affecting 76 patients were included. Median age was 73 years, 61.4% were women, median baseline modified Rankin Scale (mRS) was 2, and 55.4% had prior epilepsy. In the out-of-hospital group (n = 50), median time to emergencies was 1.3 h and to hospital admission 2.8 h. In the global series, median time to neurologist was 4.3 h, and median time to therapy initiation was 4.5 h. These four times positively correlated with SE duration (all Spearman's rho coefficient >0.5, all p < .001). SE median duration was 24 h and was extended 1.2 h for each hour of treatment delay. A longer SE duration was associated with increased mortality and morbidity, both at hospital discharge and at 3-month follow-up (both p < .05). After 3 months, mortality was 30.1%, while recovery to baseline mRS occurred in 39.5%, with an overall median mRS of 4. CONCLUSIONS: There were pervasive delays in all phases of SE attention, which conditioned a longer SE duration, and this led to increased long-term morbimortality.

Epidaily, a scale for comprehensive functional assessment of patients with epilepsy.

OBJECTIVE: To develop and validate an epilepsy-specific scale for comprehensive functional assessment of patients with epilepsy, named Epidaily. METHODS: The multidisciplinary research group created through brainstorming a list of 47 items to explore the cognitive, social, basic and instrumental functionality of the patient. A group of epilepsy experts independent of the research group evaluated the suitability of all the items, which then were selected and reviewed by the research group to conform the Epidaily scale. On a sample of 102 patients, a reliability analysis was performed, as well as a validation one using as reference scale the score on the Activities of Daily Living Questionnaire (ADLQ), which evaluates basic and instrumental functionality. RESULTS: Epidaily consisted of 10 items distributed in four dimensions, with a possible score from 0 to 100 (perfect functionality). Inter-observer reliability was excellent, with an intraclass correlation coefficient of 0.98 (95% confidence interval 0.97-0.99). Criterion validity was demonstrated by the high positive correlation of the Epidaily score with the ADLQ score (Spearman's rho coefficient 0.85, p < 0.001). Significant relation was found between ADLQ and Epidaily in the linear regression analysis (p < 001), which reported that Epidaily explains 85.5% of the variability of ADLQ (R-squared 0.85). Discriminant validity was also proved, as Epidaily allowed to classify epilepsy severity based on Cramer et al epilepsy severity classification. The median time to obtain the Epidaily score was 5 min (interquartile range 4-6). SIGNIFICANCE: Epidaily is a brief and versatile scale, with excellent inter-observer reliability, which has been validated for comprehensive functional assessment of patients with epilepsy.

Patients' knowledge on epilepsy and SUDEP improves after a semi-structured health interview.

BACKGROUND: Patients' education is the most relevant contributor to patient self-management of epilepsy. We aimed to assess the acquisition of knowledge after a semi-structured interview. METHODS: We performed a quasi-experimental prospective study with a cohort of patients with epilepsy admitted for prolonged video electroencephalogram (VEEG). We measured patients' baseline knowledge with a 10-item true-false test (test A). Then, a qualified nurse carried out a semi-structured interview. We measured acquired knowledge with another 10-item true-false exam (test B), prior to VEEG discharge and after a 3- to 5-month follow-up, and we compared the difference between the scores in test A and test B. Finally, we conducted a satisfaction and suitability survey on the interview at follow-up. RESULTS: Thirty-two patients participated, half were women. Their median age was 39.5, and the median length of schooling was 14 years. The median time since epilepsy onset was 13 years, 75% had suffered tonic-clonic seizures. The median score on test A was 7, while the median score on test B was 8.5 (p < 0.001) both at VEEG discharge and after follow-up. After the interview, 84.4% of participants reported that they were very satisfied with the information received; 87.5% stated that they had not previously heard about SUDEP (sudden unexpected dead in epilepsy); and 93.8% considered it important to receive detailed information about SUDEP. CONCLUSIONS: Patient education through a semi-structured comprehensive interview improves knowledge of patients with epilepsy about their disease. The calm atmosphere and the qualified nursing working at VEEG units make them an appropriate setting for talking about epilepsy and its risks, including SUDEP.

The usefulness of NDDI-E and QOLIE-10 scales for the screening of major depressive disorders in patients with epilepsy in video-EEG units.

OBJECTIVE: Mood disorders in patients with epilepsy are common, with depression being the most prevalent. However, this comorbidity is often underdiagnosed. The systematic use of scales such as NDDI-E and QOLIE-10 in prolonged video-EEG monitoring units could be a useful tool for the detection of this comorbidity. METHODS: Descriptive cross-sectional study of a series of patients with epilepsy evaluated in a prolonged video-EEG monitoring unit. RESULTS: Three hundred forty-nine patients were included. The mean age was 49.1 years, and 49.3% were female. 66.2% had focal epilepsy. 20.4% had pharmacoresistant epilepsy. 38.7% of patients had NDDI-E > 13. 43% of patients with focal epilepsy had NDDI-E > 13 versus 21.8% of patients with idiopathic generalized epilepsy (p = .015). Patients with focal temporal epilepsy had the highest rate of NDDI-E > 13 (48.5%). Significant association was found between patient-perceived mood and NDDI-E score (p < .001). However, in the group of patients with NDDI-E > 13, 37.6% had reported feeling "very good" or "good" in mood. Likewise, in the group that had reported feeling "very good" or "good" 21.6% had NDDI-E > 13. In 50.5% of patients with NDDI-E > 13 some kind of therapeutic intervention aimed at this comorbidity was performed. Perceived quality of life as measured by the QOLIE-10 scale was lower in patients with NDDI-E > 13 (p < .001). SIGNIFICANCE: The use of scales such as the NDDI-E and QOLIE-10 at the time of admission in video-EEG monitoring units allows screening for major depressive disorders in patients with epilepsy, which subsequently needs to be confirmed by formal assessment by a psychiatrist. Their systematic use in these units prevents some patients from going undiagnosed. Detection of these disorders allows targeted therapeutic intervention.