Influence of Marital Status on the Quality of Life of Chinese Adult Patients with Epilepsy.

BACKGROUND: Epilepsy is a chronic disorder characterized by recurrent seizures and has significant psychological and social consequence for everyday living. Epilepsy affects various aspects of ones' social life. The present study aimed to investigate the influence of marital status on the quality of life of adult Chinese patients with epilepsy. METHODS: This study surveyed 805 Chinese adults who have been clinically diagnosed with epilepsy for longer than 1 year in 11 hospitals in Beijing. In this survey, 532 (66.1%) participants were married. All of them completed the case report form with enquiries on demographic data, social factors, and illness. The marriage status of adult epileptic quality of life was the dependent variable, and demographic data and clinical data were independent variables, analyzed through the multiple linear regression analysis methods. The patients' quality of life was assessed using the Quality of Life in patients with Epilepsy-31 items (QOLIE-31) questionnaire, the Patient Health Questionnaire-9 items (PHQ-9), and the Generalized Anxiety Disorder-7 items (GAD-7). RESULTS: The PHQ-9 and GAD-7 scores in the unmarried group (PHQ-9 = 6.0 and GAD-7 = 5.0) were significantly higher than that of the married group (PHQ-9 = 4.0 and GAD-7 =3.0). The scores of married adult patients with epilepsy on QOLIE (61.8 ± 15.3) and social function (70.9 ± 22.7) were higher than the scores of the unmarried patients aged between 20 and 44 years. The scores of married adult epileptics on the QOLIE (58.4 ± 14.6) and the energy/fatigue (62.1 ± 20.4) were higher than the scores of the unmarried patients (QOLIE = 58.4 ± 14.6 and the energy/fatigue = 62.1 ± 20.4) aged between 45 and 59 years. For the adult epilepsy patients, depression, anxiety, seizures within the last year, disease course, medical expense category, and marriage* age are negatively correlated with the quality of life. Occupation, educational level, and average monthly income are closely related to the quality of life. CONCLUSIONS: Married adult epileptic patients have better quality of life than that of unmarried adult patients in young and middle-aged age groups. Unmarried adult patients with epilepsy are more anxious and depressed than married adult patients.

Influence of Occupational Status on the Quality of Life of Chinese Adult Patients with Epilepsy.

BACKGROUND: Epilepsy is one of the most common serious neurological disorders. The present study aimed to investigate the influence of occupational status on the quality of life of Chinese adult patients with epilepsy. METHODS: This study surveyed 819 subjects clinically diagnosed with epilepsy for more than 1 year in 11 hospitals in Beijing; 586 were employed (71.55%). All subjects completed the case report form with inquiries on demographic data, social factors, and illness. The patients' quality of life was assessed using the quality of life in patients with epilepsy-31 items (QOLIE-31) questionnaire. RESULTS: The QOLIE-31 score in the employed group was significantly higher than that in the unemployed group. Furthermore, the scores in all the sections (overall quality of life, energy/fatigue, emotional well-being, seizure worry, cognition, social function, and medication effects) of the employed group were higher than those of the unemployed group. Both the employed and unemployed groups achieved the highest difference in social function. The QOLIE-31 score of students was higher than those of farmers and workers. Both the students and workers scored higher in the quality of life compared with the adult peasants living with epilepsy. The students and farmers showed significant differences in QOLIE-31 score, cognition, emotional well-being, overall quality of life, energy/fatigue, and social function. In contrast, no significant difference was noted in seizure worry and medication effects across the three different kinds of occupation. CONCLUSION: Occupational status might affect the quality of life of Chinese adult patients with epilepsy, and social function is the most important contributing factor.

Apolipoprotein E ε4 Allele was Associated With Nonlesional Mesial Temporal Lobe Epilepsy in Han Chinese Population.

Apolipoprotein E (APOE) gene has been implicated as one of the genes susceptible to temporal lobe epilepsy (TLE), but the association is inconsistent. We carried out a study to investigate the association of APOEε4 allele with a subtype of TLE-nonlesional mesial temporal lobe epilepsy (NLMTLE) in Han Chinese people.T he study consisted of total 308 NLMTLE patients and 302 controls in Han Chinese. The APOE polymorphisms were genotyped using polymerase chain reaction (PCR) DNA sequencing. We compared the frequency of APOEε4 allele and carrying status between NLMTLE patients and control subjects to test for the association of APOEε4 allele with NLMTLE clinical status. Carrying status of APOEε4 allele was significantly associated with the risk of NLMTLE. No effect of APOEε4 allele was found on the age of onset, duration of epilepsy, or frequency of seizure. Moreover, there was no association between APOEε4 allele and hippocampal sclerosis (HS) or febrile convulsion (FC) history.O ur study provided an evidence that APOEε4 allele was a possible risk factor for NLMTLE, and further study with a larger sample is needed to warrant this finding.

Effects of differences in serum total homocysteine, folate, and vitamin B12 on cognitive impairment in stroke patients.

BACKGROUND: Vascular cognitive impairment-no dementia (VCIND) refers to the early or mild cognitive impairment induced by cerebral vascular injury. Research shows that serum total homocysteine (tHcy) level is an independent risk factor for cerebral vascular disease and may be closely related to cognitive function.Current studies on the tHcy level in VCIND patients are limited, and the relationship of tHcy with cognitive function remains unclear. This study aims to investigate the tHcy levels in patients with VCIND and to determine their correlation with cognitive function, as well as to provide useful clues for preventing and treating VCIND. METHODS: The tHcy, folate, and vitamin B12 levels in 82 patients with VCIND were reviewed retrospectively and compared with those of 80 stroke patients without cognitive impairment and 69 healthy controls by using the Montreal Cognitive Assessment (MoCA) scale and the event-related potential P300 to evaluate cognitive function. RESULTS: The tHcy levels in the VCIND group were higher than those in the other two groups, whereas the folate and Vitamin B12 levels in the VCIND group were lower than those of the other two groups. The tHcy levels in the stroke group were higher than those in the control group, and the folate and vitamin B12 levels in the stroke group were lower than those in the control group. The patients in the VCIND group with high tHcy exhibited lower MoCA scores and prolonged P300 latency than those in with normal tHcy. Correlation analysis showed that tHcy level is positively correlated with P300 latency period and negatively correlated with MoCA score. CONCLUSION: The tHcy levels were significantly higher and the vitamin B12 and folate levels were significantly lower in the patients with VCIND than those in the other groups. The high tHcy levels in the VCIND patients may be correlated with impaired cognitive function.

Polysomnographic abnormalities in patients with vascular cognitive impairment-no dementia.

OBJECTIVES: We aimed to investigate subjective sleep quality and polysomnographic sleep structure features in patients with vascular cognitive impairment-no dementia (VCIND). METHODS: Fifty-six patients with VCIND, 48 patients with simple stroke (without cognitive impairment), and 48 control subjects were included. The Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to analyze their sleep characteristics. The Montreal Cognitive Assessment (MoCA) was conducted to assess mental state. RESULTS: Patients with VCIND had higher PSQI scores compared with control subjects and simple stroke patients (P<.01). PSG revealed that patients with VCIND or stroke were more likely to experience prolonged sleep latency (SL), decreased sleep efficiency (SE), increased arousal, and reduced deep sleep and rapid eye movement (REM) sleep than controls. Patients with VCIND had significantly longer SL, increased periodic leg movements in sleep (PLMS), decreased SE, and increased arousal and sleep fragmentation compared to patients with simple stroke (P<.05). In VCIND patients, a significant positive correlation was found between SE and MoCA scores (r=0.632; P<.001), though PSQI, SL, and arousal index were significantly negatively associated with MoCA scores (r=-0.787, -0.740, -0.772, respectively; P<.001 for all). CONCLUSIONS: VCIND patients had different abnormal sleep features, including decreased SE, increased PLMS, and prolonged SL and sleep fragmentation. Abnormal sleep in VCIND may be associated with cognitive impairment.

Hemispherectomy in adults patients with severe unilateral epilepsy and hemiplegia.

OBJECTIVES: To study postoperative seizure control of hemispherectomy in adults with epilepsy and evaluate changes of movement and speech function, intelligence quotient (IQ) and quality of life (QOL) after hemispherectomy. METHODS: We retrospectively analyzed 25 adults who presented severe unilateral epilepsy and hemiplegia and underwent anatomic or functional hemispherectomy in between 2006 and 2011. Surgical outcomes, including seizure-control at last follow-up, changes of aphasia quotient, hemiplegic side motor function, IQ and QOL from pre-operative to 2 years follow-up, were investigated. Results were statistically analyzed with SPSS 18.0. RESULTS: Nine functional hemispherectomies and 16 anatomic hemispherectomies were performed. Ninety-two percent of patients were seizure-free and 8% displayed Engel II grade seizure control after the procedure. Impaired movement function was present in 9 (36%) adults' upper limbs and 5 (20%) patients' lower limbs. The patients with age at seizure onset <3 years showed improvement in mean motor function of the upper limbs. Impaired speech was seen in 7 patients with left hemispherectomies. There was an overall improvement in the mean aphasia quotient and significant difference was found in amount of change in aphasia quotients between patients with different ages of onset. All of the patients' postoperative scores of overall QOL, full IQ, verbal IQ and performance IQ improved compared with pretreatment scores and those improvements were not associated with patient's age at seizure onset or surgical approach. However, significant difference was found in change of verbal IQ between patients with right hemispherectomies and those with left hemispherectomies. Surgical complications included a single case of hydrocephalus, and 6 transient complications. CONCLUSIONS: Hemispherectomy presented good seizure control and improvement in QOL and IQ, and impairment on motor and speech function were mild. Furthermore, patients with early seizure onset could maintain movement function of upper limb and speech function improvement. Therefore, it is worth pursuing hemispherectomy in well-selected adults with severe unilateral epilepsy and hemiplegia.

Long-term outcomes of epilepsy surgery in school-aged children with partial epilepsy.

The pediatric epileptic spectrum and seizure control in surgical patients have been defined in developed countries. However, corresponding data on school-aged children from developing countries are insufficient. We summarized epileptic surgical data from four centers in China, to compare surgical outcomes of school-aged children with intractable partial epilepsy from China and those from developed countries, and introduce surgical candidate criteria. Data from 206 children (aged 6-14 years) undergoing surgical resection for epilepsy between September 2001 and January 2007 were selected. Postoperative freedom from seizures was achieved in 173 cases (84.0%) at 1 year, 149 (72.3%) at 3 years, and 139 (67.5%) at 5 years. Patients with focal magnetic resonance imaging abnormalities and a short history of seizure were most likely to become seizure-free postoperatively. Those with preoperative low intelligence quotients who became seizure-free postoperatively achieved improvements in full memory quotients, intelligence quotients, and overall quality of life at 2 years. Significant differences were evident in mean changes of full intelligence quotient, full memory quotient, and overall quality of life between patients with preoperative low intelligence quotients who received corpus callosotomies and those with a normal preoperative intelligence quotient, and between seizure-free children and those with continual seizures.

[Related factors on quality of life in 291 outpatient adults with epilepsy].

OBJECTIVE: To assess and explore the quality of life and related factors among 291 outpatient adults with epilepsy. METHODS: From July, 2005 to July, 2006, eligible outpatient epilepsy in a hospital was evaluated by the scale on quality of life in epilepsy-31 (Chinese version). RESULTS: The total scores of quality of life was low (56.46 +/- 16.58). The scores of quality of life in each item were as follows: seizure worry (45.01 +/- 25.25); overall quality of life (56. 12 +/- 16.37); emotional well-being (59.35 +/- 19.56); cognitive function (58.58 +/- 22.41); energy/fatigue (59.12 +/- 18.98); medication effects (40.45 +/- 24.44) and social function (53.00 +/- 26.36). The quality of life of patients with different education background, drug intake and side effects was different significantly (P < 0.05). Data on Multi-linear regression showed that education background, side effects would affect the quality of life. CONCLUSION: The quality of life of outpatient adults with epilepsy was low with education background, while side effects and drugs intake might serve as important factors affecting the quality of life with epilepsy.

Reliability and validity of a Chinese version of the Quality of Life in Epilepsy Inventory (QOLIE-89).

OBJECTIVE: The aim of the work described here was to develop and validate a Chinese version of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89). METHODS: The original English version of the QOLIE-89 was adapted to the Chinese language through a translation-retranslation procedure. The inventory was then completed by 293 adult patients with epilepsy. Forty patients also completed the Chinese version of the QOLIE-31. Test-retest and internal consistency reliabilities, criterion validity, and discriminative validity were assessed. RESULTS: Test-retest reliability (Pearson's correlation coefficient) for the Chinese version of the QOLIE-89 ranged from 0.70 to 0.98, and internal consistency reliability (Cronbach's alpha) ranged from 0.70 to 0.99. Spearman's rank correlation between the total scores on the Chinese versions of the QOLIE-89 and QOLIE-31 was 0.97, and domain scores ranged from 0.86 to 1.00. QOLIE-89 items could be used to discriminate between patients with respect to epileptic seizure severity and antiepileptic drug side effects. CONCLUSION: The psychometric properties of the Chinese version of the QOLIE-89 are good and similar to those of the American version and can be applied to assess quality of life in adult patients with epilepsy in China.

[Sub-classification of temporal lobe epilepsy and clinical and etiological characteristics thereof].

OBJECTIVE: To study the sub-classification of temporal lobe epilepsy (TLE) and clinical and etiological characteristics thereof. METHODS: The clinical data of 190 patients with TLE, aged 1.5 approximately 67, were analyzed. The sub-classification was based on clinical manifestations and electroencephalographic recording. The etiology of TLE was mainly concluded from both clinical history and neuroimaging. RESULTS: 172 patients were subclassified as with mesial temporal lobe epilepsy (MTLE), of which 62.2% had auras such as epigastric abnormal sensation and 67.4% had automatism, especially oroalimentary automatism. The electroencephalography recording of the MTLE patients showed interictal epileptic paroxysm discharges over the anterior or mid-anterior temporal areas. The main etiological factors related to MTLE were hippocampal sclerosis, intracranial infection, tumor, cerebrovascular disease, and trauma. Ten patients were subclassified as with lateral temporal lobe epilepsy (LTLE), all presenting auras such as acoust. The electroencephalography recording showed interictal epileptic paroxysm discharges over the posterior or mid-posterior temporal areas. The main etiological factors were trauma, tumor, and atrophy in the LTLE group. Eight patients were unable to be sub-classified. CONCLUSION: Electroencephalography is the main base for classification of TLE. Subclassification of TLE is important in the selection of treatment strategies.