Suicidality and its risk factors in tension-type headache patients: A multicenter case-control study.

This study evaluated suicidality and its risk factors in patients with tension-type headache (TTH). We recruited new patients with TTH who visited general hospitals. We recorded their clinical characteristics and conducted the Headache Impact Test-6 (HIT-6) and the Insomnia Severity Index (ISI) for assessment. We also interviewed the patients to identify major depressive disorder (MDD), generalized anxiety disorder (GAD), and suicidality with the Mini International Neuropsychiatric Interview-Plus Version 5.0.0 (MINI). The frequency of suicidality was compared between TTH patients and healthy controls. Major risk factors for suicidality were also determined. A total of 332 TTH patients with the same number of healthy controls were recruited from five general hospitals. Suicidality was observed in 82 (24.7%) TTH patients. The frequency of suicidality was significantly higher in patients with TTH than in the controls. Furthermore, the frequency of suicidality was higher in patients with chronic TTH (CTTH) than in the controls. The major risk factors for suicidality were MDD, GAD, a low education level, insomnia, chronicity of TTH, and pericranial tenderness. Suicidal ideation or attempt seems to be a common feature in TTH. Therefore, it is important to identify risk factors related to suicidality in TTH patients, which may help reduce suicidality.

Usefulness of the Liverpool Adverse Events Profile for predicting a high risk of suicidality in people with drug-resistant epilepsy.

PURPOSE: Suicidality including suicidal ideation and attempt has been a critical issue in people with epilepsy, especially in people with drug-resistant epilepsy (PWDRE). Clinicians commonly ask about adverse effects of antiepileptic drugs (AEDs) using something like the Liverpool Adverse Events Profile (LAEP) at epilepsy clinics, but suicide is usually not of interest. A high risk of suicidality can increase mortality by committing suicide in PWDRE. This study aimed to investigate whether clinicians can discern a high risk of suicidality in PWDRE by referring to the LAEP. METHODS: We recruited PWDRE, aged from 19 to 68. They completed the 21-item LAEP, the suicidality module of the Mini International Neuropsychiatric Interview, and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Through receiver operating characteristic curve analysis, we tested the usefulness of LAEP to detect a high risk of suicide. By this, we determined each cutoff point of the total LAEP score and the number of severe LAEP items, for detecting the risk. RESULTS: A hundred forty-four PWDRE participated in this study. Among them, 36 PWDRE (25.0%) had a high risk of suicidality. Either >45 of the total LAEP score or >8 of the number of severe LAEP items was a suggested optimal cutoff point for discerning the high risk of suicidality. LAEP had a correlation with the suicidality item of the NDDI-E. CONCLUSION: The LAEP may inform a high risk of suicidality in PWDRE. Referring to this, clinicians can discern suicidal problems in their epilepsy clinics.

Clinical significance of sensory hypersensitivities in migraine patients: does allodynia have a priority on it?

OBJECTIVES: This study investigated to identify the clinical significance of allodynia compared with other sensory hypersensitivities (SH) in migraine patients. METHODS: New patients with migraine were recruited from a headache clinic, and we collected data regarding their clinical characteristics and identified SH including photophobia, phonophobia, osmophobia, and allodynia. The patients completed the 12-item Allodynia Symptom Checklist, Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Insomnia Severity Index (ISI), Fatigue Severity Scale (FSS), and Migraine-Specific Quality of Life Questionnaire Version 2.1. We divided the patients into three groups: SH with allodynia (group 1), SH without allodynia (group 2), and no SH (group 3). Clinical characteristics, psychosomatic features, and quality of life (QOL) were compared among these groups. RESULTS: A total of 312 migraine patients participated in the study. Among them, 58 (18.6%), 202 (64.7%), and 52 (16.7%) were allocated to groups 1, 2, and 3, respectively. Chronic migraine, family history of migraine, medication overuse headache, earlier age at onset, longer disease duration, higher headache intensity, and aggravation with physical activity were more prevalent in group 1 than in groups 2 or 3. Scores of the MIDAS, HIT-6, PHQ-9, GAD-7, ISI, and FSS were the highest in group 1, followed by groups 2 and group 3. The lowest QOL was noted in group 1, followed by groups 2 and group 3. CONCLUSIONS: This study revealed that SH in migraine, particularly combined with allodynia, may result in poor clinical outcomes.

Aggression and its association with suicidality in migraine patients: a case-control study.

BACKGROUND: To identify aggression and its association with suicidality in migraine patients. METHODS: We enrolled 144 migraine patients who made their first visit to our headache clinic. We collected data regarding their clinical characteristics and the patients completes the Aggression Questionnaire (AQ) and other questionnaires. We also interviewed patients with the Mini International Neuropsychiatric Interview-Plus Version 5.0.0 (MINI) to identify their suicidality. The degree of aggression in migraine patients was compared to the degree of aggression in healthy controls. Major determinants for aggression and its association with suicidality were also examined. RESULTS: The overall AQ score and anger and hostility subscale scores were higher in migraine patients than controls. For migraine chronicity, patients with chronic migraine (CM) had a higher overall AQ score and physical aggression, anger, and hostility subscale scores than controls. On the other hand, all AQ scores in patients with episodic migraine were not different from the scores of the controls. Although several factors were associated with the overall AQ score, major determinants were anxiety (ß = 0.395, p < 0.001), headache intensity (ß = 0.180, p = 0.016), and CM (ß = - 0.165, p = 0.037). Patients who had suicidality based on the MINI showed a higher overall AQ score than patients without suicidality (p < 0.001). CONCLUSIONS: Aggression is likely to be a common feature in CM. Comorbid aggression may help to identify suicidality in migraine patients.

The relationship between alexithymia and headache impact: the role of somatization and pain catastrophizing.

PURPOSE: The present study compared psychological factors (i.e., alexithymia, somatization, pain catastrophizing (PC), anxiety, and depression) and QOL for headache patients and headache-free individuals, and examined whether somatization and PC mediate the relationship between alexithymia and headache impact in headache patients. METHODS: Study participants consisted of 123 headache patients from an outpatient clinic at a university hospital and 124 headache-free individuals in Daegu, Korea. The survey employed the somatization and anxiety subscales of the Symptom Checklist-90-revised, the Patient Health Questionnaire-9, Pain Catastrophizing Scale, Toronto Alexithymia Scale, Short-Form Health survey-8 (SF-8), and the Headache Impact Test-6. RESULTS: Headache patients showed a higher level of all psychological factors and lower level of two summary scores (physical and mental health) as well as the seven dimensions of the SF-8 compared with headache-free individuals. Examination employing the SPSS Process macro found that the direct effect of alexithymia on headache impact was not significant after controlling for somatization and PC. The total indirect effects of alexithymia on headache impact were significant without anxiety and depression as covariates with the significant indirect effects of alexithymia on headache impact via somatization or via PC as well as via somatization and PC. However, after controlling for anxiety and depression, PC was the only significant pathway through which alexithymia was related to headache impact. CONCLUSIONS: Headache patients may benefit from interventions aiming at improving psychological factors in order to improve the functioning and QOL of headache patients.

Depression in people with epilepsy: How much do Asian colleagues acknowledge it?

PURPOSE: The purpose of this review was to investigate the prevalence of depression in people with epilepsy (PWE) in different countries in Asia. METHODS: We searched the electronic database PubMed on June 13, 2017 for articles in English that included the following search terms: "epilepsy" AND "depression" AND "country name" for all Asian countries since 1947. Relevant original studies from Asia were included if they reported the prevalence of depression in PWE. Papers studying special populations (e.g., elderly, veterans, etc.) were not included. In addition, experts in epilepsy field were invited from some Asian countries for an in-depth assessment. RESULTS: Six hundred eighty-seven papers were reviewed and 26 related studies were included in this study. Depression is highly prevalent in PWE in different countries in Asia and the prevalence rates are consistent with rates reported in the literature from other countries: overall, about 25% of PWE suffer from depression. CONCLUSION: In Asian countries, as elsewhere, depression is common in PWE. High quality data is scarce in many countries and validated screening tools [e.g., Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)] to appropriately investigate the prevalence of depression in PWE are still lacking in many languages. Considering the high prevalence of depression among PWE, routine and periodic screening of all PWE for early detection and appropriate management of depression would be a reasonable approach.

Significance of fatigue in patients with migraine.

Fatigue is often stated as a headache trigger or migraine-specific symptom. We investigated predictors of fatigue and its impact on quality of life (QOL) in patients with migraine. Patients with migraine were recruited from a headache clinic and completed psychosomatic instruments, including the 12-item Allodynia Symptom Checklist (ASC-12), the Migraine Disability Assessment Scale (MIDAS), the Patients Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Epworth Sleepiness Scale (ESS), the Insomnia Severity Index (ISI), the Fatigue Severity Scale (FSS), and Migraine-Specific Quality of Life Questionnaire (MSQ). Two hundreds twenty-six patients with migraine were eligible for the study. Pathologic fatigue was manifested in 133 patients (58.8%). The FSS score was significantly associated with age, age of onset, the Visual Analog Scale (VAS) depicting headache intensity, photophobia, phonophobia, and the scores of the ASC-12, the MIDAS, the ESS, the ISI, the PHQ-9 and the GAD-7. The strongest predictor for the FSS was the PHQ-9 (ß = 0.432, p < .001), followed by age (ß = -0.169, p = .002), the ISI (ß = 0.151, p = .016), and the VAS (ß = 0.139, p = .018). There was an inverse correlation between the FSS score and three dimensional scores of the MSQ (p < .001). Appropriate interventions for depression, insomnia, and headache intensity are likely to lessen fatigue and improve QOL.

Unblinded, randomized multicenter trial comparing lamotrigine and valproate combination with controlled-release carbamazepine monotherapy as initial drug regimen in untreated epilepsy.

PURPOSE: To compare controlled-release carbamazepine monotherapy (CBZ-CR) with lamotrigine and valproate combination therapy (LTG + VPA) in equivalent total drug load, as initial drug regimen in untreated patients with partial and/or generalized tonic-clonic seizures (GTCS). METHODS: This unblinded, randomized, 60-week superiority trial recruited patients having two or more unprovoked seizures with at least one seizure during previous three months. After randomization into CBZ-CR or LTG + VPA, patients entered into eight-week titration phase (TP), followed by 52-week maintenance phase (MP). Median doses of CBZ-CR and LTG + VPA were 600 mg/day and 75 mg/day + 500 mg/day, respectively. Primary outcome measure was completion rate (CR), a proportion of patients who have completed the 60-week study as planned. Secondary efficacy measures included seizure-free rate (SFR) for 52-week of MP and time to first seizure (TTFS) during MP. RESULTS: Among 207 randomized patients, 202 underwent outcome analysis (104 in CBZ-CR, 98 in LTG + VPA). CR was 62.5% in CBZ-CR and 65.3% in LTG + VPA (p = 0.678). SFR during MP was higher in LTG + VPA (64.1%) than CBZ-CR (47.8%) (P = 0.034). TTFS was shorter with CBZ-CR (p = 0.041). Incidence of adverse effects (AEs) were 57.7% in CBZ-CR and 60.2% in LTG + VPA and premature drug withdrawal rates due to AEs were 12.5% and 7.1%, respectively, which were not significantly different. CONCLUSION: CR was comparable between LTG + VPA and CBZ-CR, however, both SFR for 52-week MP and TTFS during MP were in favor of LTG + VPA than CBZ-CR. The study suggested that LTG + VPA can be an option as initial drug regimen for untreated patients with partial seizures and/or GTCS except for women of reproductive age.

Validity of the Liverpool Adverse Events Profile as a Screening Tool for Detecting Comorbid Depression or Anxiety Disorder in People with Epilepsy.

BACKGROUND AND PURPOSE: The Liverpool adverse events profile (LAEP) is useful for detecting and monitoring the adverse effects of antiepileptic drugs (AEDs) and contains items related to symptoms of depression or anxiety. This study evaluated the usefulness of the LAEP for detecting comorbid depression or anxiety disorder in people with epilepsy (PWE). METHODS: PWE, aged from 18 to 70 years and who took AEDs for at least 1 year, were included. They completed the Korean version of the LAEP (K-LAEP) to detect the adverse effects of AEDs and the mini international neuropsychiatric interview-plus version 5.0.0 (MINI) to identify major depressive disorder (MDD) and generalized anxiety disorder (GAD). We validated the K-LAEP as a screening tool for coexisting MDD or GAD in PWE. Receiver operating character (ROC) curve analyses were used to measure the appropriateness of cutoff scores for the total and item K-LAEP scores for detecting MDD or GAD. RESULTS: The study enrolled 150 PWE. According to the MINI, 30 PWE (20.0%) had MDD and 26 (17.3%) had GAD. Cronbach's α coefficient of the K-LAEP was 0.939. For the total K-LAEP score, cutoff scores of 40 and 43 could detect MDD and GAD, respectively. For the K-LAEP item score, a cutoff of five could detect MDD or GAD. CONCLUSIONS: The K-LAEP is a valid screening tool for detecting MDD and GAD in PWE. A high LAEP score suggests comorbid psychiatric disorders, which need further specific evaluation.

Apathy in people with epilepsy and its clinical significance: A case-control study.

PURPOSE: Apathy as a state of decreased motivation has not been highlighted in people with epilepsy (PWE). We investigated its clinical significance in PWE. METHODS: We invited adult PWE who had been administered antiepileptic drugs (AEDs) for at least 1year and compared them with age- and gender-matched healthy controls. Eligible participants completed several questionnaires including the Apathy Evaluation Scale-Self (AES-S), the Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), the Generalized Anxiety Disorder-7 (GAD-7), the Epworth Sleepiness Scale (ESS), and the Insomnia Severity Index (ISI), and the Quality of Life in Epilepsy-10 (QOLIE-10). We investigated the degree of interictal apathy in PWE compared with controls and identified its predictors. We also measured the impact of apathy on patients' QOL. RESULTS: The mean overall AES-S score in PWE was similar to that of controls. However, the score was significantly higher in patients with uncontrolled epilepsy than controls (p<0.01). Among subscale scores of the AES-S, the mean behavioral score was significantly higher in PWE than controls (p<0.01). Education level, employment, household income, disease duration, AED-related factors, seizure control, and scores of the K-NDDI-E, GAD-7, ESS, and ISI were associated with the overall AES-S score by univariate analyses. However, major predictors were the K-NDDI-E (ß=0.476, p<0.001) and duration of AED intake (ß=0.151, p<0.01). The degree of apathy was significantly higher in patients receiving AEDs for 20 years or more than those receiving AEDs for 1-9 years (p<0.01). The overall AES-S score was inversely correlated with the overall QOLIE-10 score (p<0.001). CONCLUSION: Duration of AED intake in PWE seems to be a critical factor for apathy regardless of comorbid depression.

Perceived stress in patients with migraine: a case-control study.

BACKGROUND: Perceived stress is the most common trigger for migraine. The objective of this study was to examine the clinical significance of perceived stress in migraine patients. METHODS: This is a case-control study. Consecutive migraine patients who visited a tertiary care hospital were enrolled for this study. They completed self-reported questionnaires including Perceived Stress Scale (PSS), 12-item Allodynia Symptom Checklist (ASC-12), Migraine Disability Assessment Scale (MIDAS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Migraine-Specific Quality of Life Questionnaire (MSQ). Degree of perceived stress in migraine patients was measured and compared to that in healthy controls. Predictors for perceived stress and their impact on quality of life (QOL) of migraine patients were also determined. RESULTS: A total of 227 migraine patients were eligible for this study, including 103 (45.4%) who had chronic migraine (CM). Mean PSS score was significantly (p < 0.05) higher in CM patients than that in controls after adjusting for education, depression, and anxiety. Although several factors were associated with PSS score, major predictors for PSS were GAD-7 score (ß = 0.358, p < 0.001), PHQ-9 score (ß = 0.304, p < 0.001), ISI score (ß = 0.154, p = 0.005), and CM (ß = -0.104, p = 0.027). There was an inverse relationship between PSS scores and three-dimensional scores of MSQ (p < 0.001). CONCLUSIONS: Chronic migraine is a critical factor for perceived stress. Perceived stress affects QOL of migraine patients.

Validation of the Korean Migraine-Specific Quality of Life Questionnaire Version 2.1 in Episodic and Chronic Migraine.

AIMS: To evaluate the validity of the Korean Migraine-Specific Quality of Life Questionnaire version 2.1 (K-MSQ v 2.1) in patients with episodic migraine (EM) or chronic migraine (CM). METHODS: Subjects were recruited from a headache clinic and completed several self-report instruments, including the K-MSQ v 2.1, the Migraine Disability Assessment Scale (MIDAS), the Headache Impact Test-6 (HIT-6), the Migraine-Specific Quality of Life (MSQoL), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). Some of the subjects were assessed 4 weeks later and underwent the K-MSQ v 2.1 to examine test-retest reproducibility. Internal consistency and test-retest reproducibility were assessed to determine reliability. Construct validity was also assessed. Internal consistency (Cronbach's α) and test-retest reproducibility (intraclass correlation coefficients) were assessed to determine reliability. Pearson correlations were used to determine the validity. RESULTS: For the 180 eligible patients, the value of Cronbach's α for the three dimensions of the K-MSQ v. 2.1 (Role Function-Restrictive, Role Function-Preventive, and Emotional Function) were 0.954, 0.909, and 0.898, respectively, indicating excellent internal consistency. The intraclass correlation coefficients between baseline and the 4-week retest showed reliable reproducibility. The scores of the three dimensions for the K-MSQ v. 2.1 were well correlated with scores for the MIDAS, the HIT-6, the MSQoL, the PHQ-9, and the GAD-7. Internal consistency and construct validity showed similar tendencies in patients with EM and those with CM. CONCLUSION: The K-MSQ v 2.1 is a reliable and valid screening tool for evaluating QoL in patients with EM and CM.

PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps-an ILAE PNES Task Force report.

An international consensus clinical practice statement issued in 2011 ranked psychogenic nonepileptic seizures (PNES) among the top three neuropsychiatric problems. An ILAE PNES Task Force was founded and initially charged with summarizing the current state of the art in terms of diagnosis and treatment, resulting in two publications. The first described different levels of diagnostic certainty. The second summarized current knowledge of management approaches. The present paper summarizes an international workshop of the ILAE PNES Task Force that focused on the current understanding and management of PNES around the world. We initially provide a knowledge update about the etiology, epidemiology, and prognosis of PNES-in adults and in special patient groups, such as children, older adults, and those with intellectual disability. We then explore clinical management pathways and obstacles to optimal care for this disorder around the world by focusing on a number of countries with different cultural backgrounds and at very different stages of social and economic development (United Kingdom, U.S.A., Zambia, Georgia, China, and Japan). Although evidence-based methods for the diagnosis and treatment of PNES have now been described, and much is known about the biopsychosocial underpinnings of this disorder, this paper describes gaps in care (not only in less developed countries) that result in patients with PNES not having adequate access to healthcare provisions. A range of challenges requiring solutions tailored to different healthcare systems emerges. Continued attention to PNES by the ILAE and other national and international neurologic, psychiatric, and health organizations, along with ongoing international collaboration, should ensure that patients with PNES do not lose out as healthcare services evolve around the world.

Social support for people with epilepsy in China.

The aim of this study was to better understand social support in adult people with epilepsy (PWE) in China and to explore the factors related to weaker or stronger social support in PWE when compared with a group of matching healthy controls. Consecutively, we recruited PWE from the epilepsy outpatient clinic of the West China Hospital and healthy controls from nearby urban and rural areas. People with epilepsy and healthy controls were gender- and age-matched. Each participant was interviewed and completed the following instruments: the Social Support Rating Scale (SSRS) and the Hospital Anxiety and Depression Scale (HADS). In addition, we measured quality of life (QoL) in PWE using the Quality of Life in Epilepsy Inventory (QOLIE-31). We compared the SSRS scores between PWE and healthy controls and searched for relevant factors using correlation and regression analyses. The results showed that PWE scored lower on the SSRS than healthy controls. For PWE, early onset and depression were related to weaker social support. In healthy controls, being married and being psychiatrically healthy (i.e., scored lower on the HADS) were related to stronger support. Family members, especially parents and spouses, were the most powerful supporters for PWE and healthy people, but PWE relied on their families to a greater extent. Early intervention and psychiatric treatment are important to address and improve social support for PWE.

Interictal irritability and associated factors in epilepsy patients.

PURPOSE: Irritability has been reported in epilepsy patients. We identified associated factors for interictal irritability in epilepsy patients. METHOD: Adult epilepsy patients who received antiepileptic drugs (AEDs) for at least 1year were invited to participate in this study. For eligible patients, several questionnaires, such as the Irritability in Adult Patients with Epilepsy (I-Epi), the Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), the Generalized Anxiety Disorder-7 (GAD-7), the Epworth Sleepiness Scale (ESS), and the Insomnia Severity Index (ISI), were administered. We investigated factors for determining the overall I-Epi score using univariate and multivariate analyses. RESULTS: A total of 276 patients with epilepsy were included in the study. Mean duration of epilepsy was 15.4 years (2-58 years), and 146 patients (52.9%) had a seizure freedom for 1year. Mean overall I-Epi score was 46.1 (18-105), and 163 patients (59.1%) had at least a moderate level of irritability. Although several factors, including demographic, socioeconomic, psychosomatic, epilepsy-related factors, and levetiracetam intake, were associated with the overall I-Epi score, the strongest factor was the K-NDDI-E score, followed by the ISI score, the GAD-7 score, the ESS score, seizure control, and duration of epilepsy. CONCLUSION: An appropriate management of psychosomatic problems and epileptic attacks is likely to reduce irritability in epilepsy patients. Acknowledgment of irritability by clinicians will reduce drug failure when they administer AEDs with negative psychotropic profiles, especially irritability and aggression.

Cutaneous Allodynia and Its Risk Factors in Korean Patients with Migraine: A Survey of Two Tertiary Care Hospitals.

AIMS: To measure the prevalence of cutaneous allodynia in Korean patients with migraine and to characterize the differential risks of migraine-associated factors and psychiatric disorders in its development. METHODS: The study included consecutive patients with migraine who visited headache clinics at two tertiary care hospitals. Questionnaires including the 12-item Allodynia Symptom Checklist (ASC-12) and the Migraine Disability Assessment (MIDAS) were administered to the patients. The Mini International Neuropsychiatric Interview-Plus, Version 5.0.0 (MINI), was performed to diagnose current major depressive disorder (MDD) and current generalized anxiety disorder (GAD). To determine the predictive factors of cutaneous allodynia, a two-step logistic regression model was used. RESULTS: A total of 332 patients were eligible for the study. Chronic migraine (CM) was present in 140 patients (42.2%). Current MDD and current GAD were identified in 73 (21.9%) and 59 patients (17.7%), respectively. Cutaneous allodynia was present in 48 patients (14.5%). Univariate analyses indicated that cutaneous allodynia was associated with female gender, CM, medication overuse headache, headache intensity, photophobia, phonophobia, MIDAS grade, current MDD, and current GAD. Multivariate analyses revealed that current MDD was the strongest risk factor for cutaneous allodynia (adjusted odds ratio [AOR] = 4.552; 95% confidence intervals [CI] = 2.300-9.007; P = .000), followed by CM (AOR = 3.666; 95% CI = 1.787-7.521; P = .000) and photophobia (AOR = 2.707; 95% CI = 1.340-5.469; P = .005). CONCLUSION: Korean patients with migraine have a low prevalence of cutaneous allodynia. Both depression and migraine-associated features are important factors in the occurrence of cutaneous allodynia.

Perceived stress and its predictors in people with epilepsy.

OBJECTIVE: Perceived stress in people with epilepsy (PWE) is one of the major precipitants for seizures. We investigated the degree of perceived stress in PWE and its predictors. We also aimed to reveal the interrelationships among the predictors. METHODS: This was a case-control study. Consecutive patients visiting a tertiary care epilepsy clinic completed self-reported questionnaires including the Perceived Stress Scale (PSS), Revised Stigma Scale (RSS), Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), Generalized Anxiety Disorder - 7 (GAD-7), and short forms of the Patient-Reported Outcomes Measurement Information System - Sleep Disturbance (PROMIS-SD) and Patient-Reported Outcomes Measurement Information System - Sleep-Related Impairment (PROMIS-SRI) scales. RESULTS: The mean score of the PSS was significantly lower in patients with well-controlled epilepsy (WCE) and higher in those with uncontrolled epilepsy compared with controls. Although several factors including demographic, socioeconomic, psychosomatic, and epilepsy-related factors were associated with the PSS score, the strongest predictor for the PSS score was the K-NDDI-E score, followed by the PROMIS-SRI score, the GAD-7 score, and seizure control. Psychosomatic factors exerted both a direct effect on the PSS score and an indirect effect on the PSS score through seizure control. CONCLUSION: Rapid detection and appropriate management of psychiatric and sleep-related problems in PWE may lessen stress and aid in preventing further seizures.

Interictal fatigue and its predictors in epilepsy patients: A case-control study.

PURPOSE: Fatigue impairs the quality of life (QOL) of epilepsy patients, but few studies have investigated this issue and no systematic analysis of the predictors of fatigue in epilepsy patients has been performed. Thus, we investigated the degree and predictors of fatigue in epilepsy patients. METHODS: We enrolled 270 consecutive adult patients with epilepsy and categorized them into three subgroups: uncontrolled epilepsy (UCE), well-controlled epilepsy (WCE), and poorly controlled epilepsy (PCE). All subjects were asked to complete the Korean versions of the Fatigue Severity Scale (K-FSS), the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), the Generalized Anxiety Disorder-7 (K-GAD-7) scale, and the short forms of the Patient-Reported Outcomes Measurement Information System Sleep-Related Impairment (PROMIS-SRI) and Sleep Disturbance (PROMIS-SD) scales. Additionally, 200 normal control subjects who completed the K-FSS, K-NDDI-E, and K-GAD-7 measures were included. The K-FSS scores of the epilepsy subgroups and the control group were compared, and stepwise multiple regression analysis was performed to identify predictors of high scores on the K-FSS among epilepsy patients. RESULTS: The K-FSS, K-NDDI-E, and K-GAD-7 scores were higher in the epilepsy patients than in the controls. The K-FSS scores of the UCE subgroup, but not of the PCE and WCE subgroups, were higher than those of the control group. K-FSS scores of epilepsy patients were predicted by PROMIS-SRI and K-NDDI-E scores. CONCLUSIONS: Fatigue was more severe in epilepsy patients than in healthy controls without epilepsy, especially when seizures were not controlled. Sleep-related impairments and depression aggravated fatigue in epilepsy patients.

Factors associated with frovatriptan response in patients with migraine: A prospective, observational study.

BACKGROUND: Almost one-third of patients with migraine do not adequately respond to triptans. We examined factors contributing to frovatriptan response in patients with migraine. METHODS: We enrolled new patients with migraine who consecutively visited our headache clinic. Eligible patients were instructed to take 2.5 mg of frovatriptan as soon as possible after migraine attack. The responsiveness was determined by whether headache was relieved or absent within 4 hours after the intake of frovatriptan. We assessed frovatriptan to be efficacious when headache responded to its administration in at least one of two successive migraine attacks and inefficacious when headache was not relieved in either attack. We included demographic, clinical and psychiatric variables in the analysis of factors associated with frovatriptan response. RESULTS: Of 128 eligible patients, 28 (21.9%) experienced frovatriptan inefficacy. In 24 patients with current major depressive disorder, 12 (50.0%) had frovatriptan inefficacy. Only current major depressive disorder was identified as a risk factor for inefficacy (odds ratio = 5.500, 95% confidence interval 2.103-14.382, ITALIC! p = 0.001). CONCLUSIONS: Depression may be a risk factor of frovatriptan inefficacy in patients with migraine, even though half of patients with major depressive disorder respond to frovatriptan.