Health-related quality of life in adolescents with epilepsy in Montenegro.

OBJECTIVE: The objective of this study was to establish potential risk factors for poor health-related quality of life among adolescents with epilepsy in Montenegro. MATERIAL AND METHODS: A sample of 104 adolescents with epilepsy (age: 11-19years) at a tertiary referral center in Podgorica, Montenegro, completed the validated Serbian version of the QOLIE-AD-48 questionnaire. They were divided into two groups: a group with active epilepsy (60 adolescents) and a group with inactive epilepsy (44 adolescents). Demographic and clinical data were collected. RESULTS: Adolescents with active epilepsy had low quality of life and felt the negative impact of the disease. They also had more cognitive impairments, felt more stigmatized, and had considerably more distorted perception of their health than adolescents with inactive epilepsy (p<0.05). Females reported better social support than males (p<0.05). Older males had lower grades at school (p<0.05) than the younger ones. As expected, adolescents with the highest number of seizures in the past two years had the lowest quality of life (p<0.05). CONCLUSION: In our study, the quality of life in adolescents with epilepsy was determined by severity of the disease, age, and gender.

Public Awareness, Understanding and Attitudes Towards Epilepsy in Montenegro.

Stigma remains a distressing consequence of epilepsy worldwide. We assessed stigma markers among citizens of Montenegro. Randomly selected adults aged 18 to 65 were interviewed using a 10-item questionnaire, which had been used in similar settings. Descriptive statistics, χ2-test and Fisher exact test were used in order to identify factors associated with negative attitudes. After exclusions and refusals, the questionnaire was administered to 1000 people, 91% of whom had heard about epilepsy. Less than half knew someone with epilepsy and 31.5% had witnessed a seizure. One-fifth would object if their child played with a person who had epilepsy and three-quarters would object if their child married a person with epilepsy. Forty percent believed people with epilepsy should be employed in the same way as everybody else. Fewer than 8% of respondents thought epilepsy was a form of insanity. Over 80% favored brain disease as a cause of epilepsy and 95% chose convulsions to be a major feature of an epileptic attack. General awareness of epilepsy in Montenegro is similar to that in other countries. Understanding epilepsy is relatively good but the results suggest that there still are negative attitudes towards people with epilepsy.

Prevalence of epilepsy in Podgorica, Montenegro.

The purpose of this study was to assess for the first time the prevalence of epilepsy in the capital of Montenegro and to describe the clinical and epidemiological profile of the disorder. A door-to-door screening was performed on population of 6 randomly selected areas of Podgorica (capital of Montenegro) using validated screening questionnaire. In phase 1, the screening by questionnaire of 4007 individuals identified 307 suspected cases of epilepsy. Four of them dropped out of further investigation just before entering the phase 2. In phase 2, the remaining 303 suspected cases were first examined by general practioner and then by an epileptologist, on two follow-up visits. The confirmation of epilepsy was based on clinical examination. Electroencephalogram (EEG), computed tomography (CT) and/or magnetic resonance imaging (MRI) were also used. 29 persons were diagnosed with epilepsy. An overall prevalence of 7.2 cases per 1000 inhabitants was calculated (CI 95% 5.0­10.0). Majority of them had been previously diagnosed (86.20%), 27 had active epilepsy and over a half of them were on polymedication (65.51%). Referring to the 27 patients with active epilepsy, the predominant seizure type was partial (all types) in 14 (48.27%) and undetermined in 2 (6.89%). Cause of epilepsy was determined in 10 patients. EEG abnormalities were found in almost all patients (89.65%). CT anomaly was determined in 9 whereas only 1 patient had an abnormal MRI finding. The estimated prevalence of epilepsy indicated higher rates compared to neighboring counties and the rest of the Europe, but limitations of the study (high rejection rate and stigma) should be taken into consideration.

Psychiatric comorbidities among patients with epilepsy in Montenegro.

The aim of this study was to evaluate the prevalence of psychiatric comorbidities, depression and anxiety, among patients with epilepsy in the outpatient Clinic for Epilepsy, Clinical Centre of Montenegro. Patients aged 18 and above with a diagnosis of epilepsy for at least one year were consecutively enrolled during a six-month period. Patients anonymously filled out a questionnaire which included data on the gender, age, education, marital status and degree of seizure control. The Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were used to evaluate the presence or absence of anxiety and depression. Total number of study patients was 70, including 52 patients with partial seizures and 18 patients with generalized tonic-clonic seizures. The mean patient age was 37 ± 7.92 years. The prevalence of depression in our sample was 32.8%, whereas the prevalence of anxiety was 21.4%. Patients with partial seizures were more depressed, while those with idiopathic generalized seizures were more anxious (p < 0.01). Depression was associated with a lower educational level, unemployment and poor seizure control (p < 0.05). The number of antiepileptic drugs showed a trend towards negative association with depression (p = 0.005). Anxiety was associated with the level of education and uncontrolled seizures (p < 0.01). Neither depression nor anxiety was associated with age, gender, marital status, age at onset and duration of epilepsy. Psychiatric disorders among patients with epilepsy are quite common but yet under-recognized. Therefore, appropriate recognition and efficient treatment of these disorders in patients with epilepsy might improve their quality of life and could consequently lead to better treatment success.

[Disulfiram-induced polyneurophaty].

INTRODUCTION: Disulfiram is used in the treatment of chronic alcoholism, because of the unpleasant symptoms produced after ethanol intake. Although it is well tolerated in most patients, one in 15,000 patients will develop peripheral neuropathy every year, which is frequently misdiagnosed as alcoholic neuropathy. CASE REPORT: We report clinical, laboratory, electrophysiological and histopathological features in a 19-year-old patient who developed an acute distal sensorymotor neuropathy during the treatment of alcoholism. At the end of 4-month treatment with disulfiram 250 mg/day, the patient complained of weakness in distal segments of the lower limbs associated with burning dysesthesias, numbness and pain in the soles of the feet and the legs below the knees; reduction in foot strength, the absence of ankle jerk tendon reflexes, and tactile stocking pin-pick and vibratory sensory impairment in the lower limbs below the knee. Recovery was successful after treatment cessation. CONCLUSION: The significance of toxic neuropathy is shown by the fact that the recognition of clinical picture, identifying etiological factors and its elimination may prevent the evolution of polyneuropathy. This allows for more effective treatment of these neuropathies as apposite to idiopathic ones which can be treated only symptomatically. Our case report indicates the possibilities during a period with no serious damage to the axons manifested.