Evaluation of clinical aspects and quality of life as risk factors for depression in patients with epilepsy.

The purpose of this study was to investigate clinical aspects and quality of life (QOL) as risk factors for depression in patients with epilepsy. One hundred and forty outpatients with a diagnosis of epilepsy who were attending our epilepsy center participated. Patients anonymously filled out a questionnaire with clinical data related to epilepsy. Depression level was evaluated by the Hamilton Depression Rating Scale-17 (HAMD-17), and quality of life was evaluated by the Quality of Life in Epilepsy-31 (QOLIE-31). Thirty-six patients with epilepsy suffered from depression (25.7%). Complex partial seizures (OR=0.112) and number of seizure types (OR=3.773) were found to be clinical risk factors for depression. Low scores for seizure worry (OR=0.947) and social function (OR=0.947) on the QOLIE-31 increased the probability of depression in patients with epilepsy.

Treatment of epilepsy in adults: expert opinion in China.

OBJECTIVE: The goal of this study was to survey a group of epileptologists in China regarding the treatment of adult epilepsy. METHODS: A questionnaire on treatment of adult epilepsy was sent to a group of opinion leaders in the field of epilepsy. RESULTS: For initial monotherapy for idiopathic generalized epilepsy (IGE), valproate was rated as the treatment of choice. In symptomatic localization-related epilepsy (SLRE)/simple partial seizures and SLRE/complex partial seizures, carbamazepine and oxcarbazepine were the respective treatments of choice, whereas in SLRE/secondarily generalized tonic-clonic seizures, carbamazepine, lamotrigine, and oxcarbazepine were treatments of choice. For women who were pregnant or trying to conceive, lamotrigine was the treatment of choice for both IGE and SLRE. In people with epilepsy who were HBsAg positive, whether liver function was normal or not, topiramate and levetiracetam were treatments of choice for IGE. Valproate and levetiracetam were treatments of choice for seizures in the emergency department. CONCLUSION: A high level of consensus was reached on most treatments of choice and first-line treatments for patients with epilepsy, which were in accordance with published US expert opinion.

Determinants of quality of life in people with epilepsy and their gender differences.

Improving the patient's quality of life (QOL) is the most important goal of epilepsy management. We performed this study to determine the factors associated with QOL in people with epilepsy and to assess whether there are gender differences in these determinants. Patients were interviewed using the Quality of Life in Epilepsy Inventory-31(QOLIE-31), the Adverse Event Profile (AEP), the Self-Rating Anxiety Scale (SAS), and the Hamilton Depression Rating Scale (HAMD). Two hundred forty-seven patients (152 men, 95 women) were included in the analysis. Among all patients, regressive analyses showed that AEP score was the strongest predictor of the QOLIE-31 overall score, accounting for 10.4% of the variance. The next strongest predictors were the number of currently used antiepileptic drugs (AEDs) (3.6%), the HAMD score (2.5%), and the SAS score (1.2%). Importantly, there were gender differences in these predictors of QOL. The strongest predictors of the QOLIE-31 overall score in women were the AEP score and the number of AEDs. In contrast, the strongest predictors in men were the SAS score, the AEP score and the frequency of seizures. These results indicate that perceived adverse effects of treatments and number of AEDs exerted greater effects on QOL in women, whereas anxiety and seizure-related variables had a stronger impact on QOL among men. Accordingly, it may be necessary to individualize interventions to improve the QOL of people with epilepsy.

A 6-month prospective study on efficacy safety and QOL profiles of extended-release formulation of valproate in patients with epilepsy.

The goals of this study were to evaluate the efficacy, safety, and quality of life profiles of ER formulation of valproate in patients with epilepsy. This was a prospective, multicentre, open-lable study. Patients with a definite diagnosis of epilepsy were included and prescribed the ER formulation of valproate as initial or add-on therapy for 6 months. Efficacy and safety re-evaluation procedures were performed at 1 (V1), 3 (V2), and 6 months (V3) after enrollment. A QOLIE-31 inventory was used to assess the quality of life before and after the 6-month treatment. Nine hundred and fifty-eight patients with diagnosis of epilepsy were included in the analysis. The mean of seizure frequency at baseline was 8.56 per month. The median maintenance dose of the ER valproate was 750 mg per day. The number of seizure attacks per month was significantly decreased at the last visit compared to baseline by 88.3%. Patients improved quality of life in the fields of 'seizure worry' (P=0.000), 'overall quality of life' (P=0.000), 'social function' (P<0.01), and 'Question 31' (P=0.000), but showed decreased 'energy' (P=0.000). In the early phase of treatment, the main adverse effects included drowsiness, dizziness, and anorexia. By 6 months of treatment, weight gain, alopecia, and tremor were most frequently reported. The results of the present study demonstrated that patients receiving ER valproate as add-on or mono-therapy for 6 months exhibited significantly greater median percent reductions from baseline in seizure frequency for all seizure types, and significantly higher responder rates and higher seizure freedom rates, with good tolerance and improved quality of life.

[Factors associated with quality of life in epileptics and the variations between men and women, younger and older people].

OBJECTIVE: To determine factors associated with quality of life (QOL) in epileptics and the variations between men and women, younger and older people. METHODS: A total of 204 patients (160 younger, 49 older; 125 men, 79 women) were interviewed by the quality of life in epilepsy-31 (QOLIE-31), side effect profile (SEP), self-rating anxiety scale (SAS) and Hamilton depression scale (HAMD). Medical and socio-demographic data were acquired from patient records. Multivariate linear regressive analyses were used to determine the set of best predictors of composite QOLIE-31 score. RESULTS: No statistical difference was revealed in QOLIE-31 overall score either between younger and older patients or between men and women. Among all patients, regressive analyses revealed that SEP (beta = - 0.395, P = 0.000) and SAS (beta = -0.152, P = 0.016) were two strong predictors of QOLIE-31 overall score. Grouped by gender, among men, epilepsy duration (beta = -0.165, P = 0.028) and seizure frequency (beta = -0.284, P = 0.001) respectively associated with QOLIE-31 overall score and "social function" score while the number of AEDs (antiepileptic drugs) substantially correlated with QOLIE-31 overall score among women (beta= -0.238, P = 0.006). Grouped by ages, seizure frequency (beta = -0.284, P = 0.000) and education level (beta = 0.203, P = 0.005) predicted QOLIE-31 "social function" score only among younger patients; among older patients, a significant association were found between the number of AEDs and QOLIE-31 overall score (beta = - 0.363, P = 0.004). CONCLUSION: Side effects of AEDs and number of AEDs exert greater effect on QOL in women and older patients. And such seizure-related variables as epileptic duration and seizure frequency influence QOL only among men and younger patients.

International Bureau for Epilepsy survey of children, teenagers, and young people with epilepsy: data in China.

The goals of this study were to assess the perception of people with or directly involved with childhood and adolescent epilepsy in China, and to gain insight into the real-life effects that epilepsy can have on quality of life, development, and opportunities for the future. Survey questionnaires were developed by the International Bureau for Epilepsy for three groups: teenagers and young adults, parents/caregivers of children with epilepsy, and health care professionals. In total we received 968 responses from 20 cities in China. Nearly two-thirds of teenagers and young adults with epilepsy (64.9%) and two-thirds of parents/caregivers of children with epilepsy (64.0%) who responded to the survey had kept epilepsy a secret from others. When asked specifically about drug-related side effects, more than half of teenagers and young adults with epilepsy reported experiencing side effects, specifically dizziness (23.9%), weight change (22.9%), and headache (14.5%). Health care professionals reported cognitive side effects (94.2%), mood change (56.7%), and skin rash (50%) in their patients with epilepsy. More than two-thirds of the teenagers and young adults with epilepsy (75.7%) expected the condition to hinder their lives in the future, affecting their chances of getting a job (52.6%), continuing their education (35.5%), and getting a boyfriend or girlfriend (33.7%). Among parents/caregivers of children with epilepsy, 85.7% expected the condition to hinder their child's life in the future. This survey documents some of the real-life consequences of epilepsy and highlights the important challenges and issues faced by people with epilepsy and their families in China. Ensuring that people are as free from seizures as possible and minimizing the side effects of treatment must be the primary goals of epilepsy management.