The Most Frequent Psychiatric Comorbidities in Bulgarian Patients With Epilepsy: Their Connection With the Main Clinical Characteristics and Quality of Life.

AIM:  The objective of this study is to determine and compare the relationship of the most common psychiatric comorbidities in Bulgarian patients with epilepsy with the main clinical characteristics, as well as to evaluate their impact on certain aspects of the quality of life. CLINICAL RATIONALE:  Psychiatric comorbidities occur in about one-third of people with epilepsy throughout their lifetime, and their incidence is much greater in high-risk groups such as patients with treatment-resistant epilepsy. MATERIAL AND METHODS:  The study group consisted of 129 participants, of whom 104 were divided into four groups according to the presence of one of the most frequently diagnosed psychiatric comorbidities in our patients with epilepsy: personality and behavioral disorder (PBD) (n=25), mild to moderate depressive disorder (n=26), anxiety disorder (n=32), and dissociative and conversion disorders (n=21). A control group was also formed with a similar number of participants with epilepsy (n=25) without psychiatric comorbidity. Some sociodemographic and clinical characteristics of epilepsy were analyzed in all patients. All patients filled out two questionnaires: the Bulgarian version of quality of life in epilepsy - 89 (QOLIE-89) and the Bulgarian version of SIDAED (assessing SIDe effects in antiepileptic drugs (AED) treatment). RESULTS:  The analysis revealed a negative influence of psychiatric comorbidity on the presence of epileptic seizures, unwanted drug effects, and lower scores for all aspects of the quality of life of patients with epilepsy. CONCLUSION AND CLINICAL IMPLICATIONS:  The main conclusion of our study is the presence of an interaction between psychiatric comorbidity, the clinical course of the disease, and the deteriorated quality of life (QOL) in patients with epilepsy. Further attention, comprehensive care, and targeted research are needed to analyze individual psychiatric comorbidities in patients with epilepsy for early detection and treatment.

Familial hyperinsulinaemic hypoglycaemia with epileptic syndrome, cognitive impairment and detected mutation of the ABCC 8 (SUR1) gene: a case report.

Hyperinsulinaemic hypoglycaemia (HH) occurs as a consequence of unregulated insulin secretion from pancreatic beta cells. It is the most common cause of severe and prolonged hypoglycemia in newborns. HH is a major risk factor for brain damage and subsequent neurological disability, which is why the identification, rapid diagnosis, and timely treatment of patients with HH are essential for the prevention of brain damage. The present case gives a brief description of a patient with congenital HH with an established mutation in the ABCC8 gene encoding the SUR1 subunit of the K-ATP channel. The genealogical tree, the clinical picture, the diagnostic cascade, the neurological consequences and their development in dynamics are considered, with special emphasis on the epileptic syndrome and mental status. Advances in molecular genetics, radiological imaging techniques, conservative treatment, or laparoscopic surgery may completely change the clinical approach to children with severe congenital forms of HH.

Significance of noncompliance when treating patients with epilepsy.

INTRODUCTION: The absence of patient's cooperation when it comes to his/her treatment ("noncompliance") is typical to chronic diseases and it is significant problem in medical practice. The term "compliance" means patient's capability of strictly adhering to the recommendations concerning the prescribed treatment. The noncompliance with drug regime is frequent case in patients with epilepsy, it is related to increased risk of epileptic seizures' occurrence and other undesired consequences, including increased costs in the healthcare area. OBJECTIVE: The objective of our research is assessing the interconnection between compliance with the treatment and social-demographic and clinical factors in patients with epilepsy. CONTINGENT AND METHODS: The research covers 131 consecutively included patients with epilepsy of various social-demographic and clinical characteristics. We have utilized analysis of the medical documentation, anamnesis, study of the somatic and neurological status, self-assessment scales and statistical methods. RESULTS: We established statistically significant positive correlations between the number of patients with poor compliance and the absence of professional/educational occupation, frequency of epileptic seizures, number of the antiepileptic drugs taken during the present and past treatment, the simultaneous presence of poor control of epileptic seizures and adverse drug events being the reason behind the modification of the previous treatment. CONCLUSION: Patient's poor compliance, the great frequency of seizures, the higher number of antiepileptic drugs and the adverse drug reactions have negative impact on the course of the epileptic disease. The improved compliance results in optimizing the antiepileptic treatment, improving patients' condition and significantly cutting down costs incurred in the healthcare area.

Translation, cross-cultural adaptation, and validation of the Bulgarian version of the Liverpool Adverse Event Profile.

BACKGROUND: Adverse effects (AEs) of antiepileptic drugs (AEDs) affect the quality of life of patients with epilepsy and their outcomes. There are no questionnaires or studies on the reliability and validity of instruments measuring AEs of AEDs in patients with epilepsy in Bulgarian language. PURPOSE: The aim of the present study was the translation, cross-cultural adaptation, and validation of the LAEP in the Bulgarian language in order to use it in the Bulgarian-speaking population in providing a reliable instrument for the clinical monitoring of patients with epilepsy. METHODS: One hundred thirty-one patients (57 men and 74 women, mean age: 40.13±13.37 years) took part in the investigation. The internal consistency and test-retest reliability were tested by Cronbach's α and ICC estimations. The convergent construct validity was tested by estimating the correlation of the LAEP-BG with the QOLIE-89 and the discriminant validity by evaluating the difference between LAEP-BG scores and clinical parameters such as the type of epilepsy using Kruskal-Wallis ANOVA. RESULTS: The LAEP-BG showed high internal consistency and reliability. The Cronbach's α of the total scale was 0.86. No significant differences between the Cronbach's α coefficients of the total LAEP-BG and original English, Chinese, Spanish, Korean, and Portuguese-Brazilian versions of the questionnaire were observed. The ICCs, which evaluate the test-retest reliability, were higher than the recommended value of 0.75 and determined the strong positive correlations between the first and second examinations. The creation of two subscales "Neurological and psychiatric side effects" and "Non neurological side effects" of the LAEP-BG proposed by us showed good internal consistency (Cronbach's α of 0.85 and 0.71, respectively). The LAEP-BG scores significantly correlated with other questionnaires such as the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) and showed a good discriminative validity between groups with different levels of self-assessed AEs of AEDs. CONCLUSION: The Bulgarian version of the Liverpool Adverse Event Profile (LAEP) is a reliable and valid tool in assessing the patient-reported AEs of AEDs and their impact on the patient's outcome.