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3.
BMC Neurol ; 19(1): 161, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315592

RESUMO

BACKGROUND: Epilepsy is a common neurological disease with substantial impact on the subject and their caretakers. This exploratory study identified barriers to care for persons living with epilepsy (PLWE) to develop a culturally acceptable nurse led self-management intervention for PLWE previously developed in the United States. METHODS: The study involving 48 participants (31 PLWE and 17 caregivers) with in depth interviews and focus groups was conducted. We obtained insights into barriers to care in PLWE and their caregivers. Using a thematic analytic procedure emphasizing the dominant themes the qualitative responses were analyzed. Median age of PLWE was 24 years (IQR 19-30), and10 (52.6%) were male. The median age of epilepsy onset was 12 years (IQR 6-18), range of 1-37 years. The median age of caregivers was 50 years (IQR 45-50.5), with a range of 18-78 years. Seventy five percent of caregivers (6/8) were females. RESULTS: Three major areas of perceived barriers involving individual, family or community and provider and healthcare system barriers to epilepsy care emerged. Individual factors like limited epilepsy knowledge and medication non-adherence were reported to be key barriers to epilepsy care. Caregiver burden and lack of family support as well as poor health care access were identified from the family and health care systems. CONCLUSIONS: The main barrier to epilepsy care is limited epilepsy knowledge in PLWE and their caregivers. Improving epilepsy care awareness and knowledge within communities and appropriate health care provider service for epilepsy would help reduce epilepsy barriers and improve care.


Assuntos
Cuidadores/psicologia , Epilepsia/psicologia , Acesso aos Serviços de Saúde , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Epilepsia/enfermagem , Feminino , Grupos Focais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autogestão , Uganda , Adulto Jovem
4.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 1065-1071, jul.-set. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005589

RESUMO

Objetivo: descrever a percepção e a vivência de famílias de crianças com epilepsia. Método: Estudo descritivo de caráter qualitativo, realizado no município de Guarapuava/PR. Os dados foram coletados nos meses de janeiro e fevereiro de 2016, por meio de entrevistas semiestruturadas realizadas junto a sete familiares de crianças com epilepsia. Os relatos foram transcritos e submetidos à análise categorial temática. Resultados: Os resultados ressaltam o impacto social da doença na família, desde o momento do diagnóstico, com implicações para desenvolvimento de atitudes de superproteção, até mudanças na dinâmica familiar, além do enfrentamento do estigma da doença. Conclusão: O desvelamento da percepção e da vivência de famílias de crianças com epilepsia permitiu verificar em que medida estas influenciam o cuidado dispensado a elas, ao mesmo tempo em que ressalta a importância do apoio a estas famílias no cuidado, por meio de uma assistência humanizada e qualificada, pautada nas reais necessidades de cada unidade familiar


Objective: to describe the perception and the experience of families composed by children with epilepsy. Method: Descriptive study of a qualitative character, carried out in the city of Guarapuava-PR. The data were collected in the month of January and February of 2016, by means of a semi-structured instrument, it was obtained participation of 7 relatives of children with epilepsy. The reports were transcribed and submitted to the Analysis of thematic content modality. Results: they call attention to the social impact of the disease in the family, from the moment of diagnosis, with implications for the development of attitudes of overprotection, to changes in family dynamics, and the stigma of epilepsy. Conclusion: understanding the perception and the experience of families, reveals that this may influence the care of the child with epilepsy. In addition, it denotes the importance of supporting the family in care, with an assistance based on the real needs of the family and therefore, more humanized and qualified


Objetivo: describir la percepción y la vivencia de famílias compuestas por niños con epilepsia. Método: Estudio descriptivo de carácter cualitativo, realizado em El municipio de Guarapuava-PR. Los datos fueron recolectados em El mes de enero y febrero de 2016, por medio de instrumento semi estructurado, se obtuvo La participación de 7 familiares de niños con epilepsia. Los relatos fueron trascritos y sometidos al analise de Contenido modalidad temática. Resultados: llaman La atención sobre el impacto social de La enfermedad em La familia, desde el momento del diagnóstico, com implicaciones para el desarrollo de actitudes de sobre protección, hasta los câmbios ocurridos em La dinámica familiar, además del estigma de la epilepsia. Conclusión: La comprensión de La percepción y la vivencia de lãs familias, revela que ésta puede influir em el cuidado delniño con epilepsia. Además denota La importancia de apoyar a La família enel cuidado, con una asistencia pautada em lãs reales necesidades de La familia y por lo tanto, más humanizada y calificada


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adulto , Cuidado da Criança/psicologia , Saúde da Família , Epilepsia/psicologia , Enfermagem Familiar
5.
Pan Afr Med J ; 32: 93, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223384

RESUMO

Introduction: Epilepsy is one of the most prevalent neurological conditions for people of different age group, race, gender and socio-economic status in various nations, affecting 50 million people around the world; 80% of them living in developing countries. In Sudan, literature has well documented epilepsy stigma and it related elements of labelling, negative typecasting, isolation, devaluing and discrimination that are significantly affecting patients living standards and social life. This study focuses on understanding the prevailing, different types of stigma among people living with epilepsy (PWE) in Sudan and to determine its frequency in connection with demographic factors and patients coping ability of PWE. Methods: A health facility-based cross-sectional descriptive study was conducted on 270 people between the ages of 16-70years who are affected by epilepsy in an outpatient clinic. Standardized questionnaires were used to interview the patients with assistance gotten from their relative where necessary. The data is analyzed using SPSS version 20. The study was conducted in the outpatient clinic of The National Center for Neurological Sciences (NCNS), Ibrahim-Malik Teaching Hospital Sudan. Results: The study realized that 16.6% of the patient had a positive self-stigma score, half of them having coaching stigma and 25% courtesy stigma. One third of people with epilepsy had poor coping score that was strongly determined by self- stigma and courtesy stigma score. Conclusion: Parents and relatives related sigma is a major problem facing people of epilepsy in Sudan; thus, raising such group awareness and education about the disease can markedly improve the quality of life of people with epilepsy in Sudan.


Assuntos
Adaptação Psicológica , Epilepsia/psicologia , Qualidade de Vida , Estigma Social , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Sudão , Inquéritos e Questionários , Adulto Jovem
6.
Behav Neurol ; 2019: 2806341, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31178940

RESUMO

Background: Medication adherence and belief are crucial to achieving the desired goal of therapy in epileptic patients. However, there is a lack of study regarding medication adherence and belief in our setting. Therefore, the purpose of this study was to investigate medication adherence and belief and associated factors among ambulatory patients with epilepsy. Method: A cross-sectional study was conducted on randomly selected epileptic patients at the neurologic clinic of Ayder Comprehensive Specialized Hospital, Ethiopia. Medication adherence and belief were assessed using self-reported questionnaires which were developed based on the review of different literatures. Data were analyzed using binary logistic regression analysis. Result: We included a total of 292 patients. Almost two-thirds (65.4%) of the patients were nonadherent to their medications. The most common cause of nonadherence was forgetfulness (48.7%) followed by inability to get medicine (28.8) and safety concern (23.5%). The majority (78.4%) of the patients had high medication necessity belief while 44.1% had high concern belief about the potential adverse effect of their medications. Overall, 39.4% of the patients had a negative belief toward their medications. Comorbidity (AOR: 3.51, 95% CI: 1.20-10.31), seizure encounter within the last 3 months (AOR: 5.45, 95% CI: 2.48-12.00), low medication necessity belief (AOR: 3.38, 95% CI: 1.14-10.00), high medication concern belief (AOR: 4.23, 95% CI: 2.07-8.63), and negative medication belief (AOR: 4.17, 95% CI: 1.74-10.02) were predictors of medication nonadherence. Conclusion: Majority of the epileptic patients were nonadherent to their medications, and more than one-third of the patients had a negative medication belief. Low medication necessity belief, high medication concern belief, negative medication belief, comorbidity, and seizure encounter were predictors of medication nonadherence. Therefore, healthcare providers should design educational programs to enhance the patients' believe about their medication in order to improve medication adherence and overall treatment outcome.


Assuntos
Epilepsia/psicologia , Cooperação do Paciente/psicologia , Adolescente , Adulto , Idoso , Comorbidade , Estudos Transversais , Etiópia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários
7.
Infect Dis Poverty ; 8(1): 34, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109376

RESUMO

BACKGROUND: In onchocerciasis-endemic areas, particularly in those with a sub-optimal onchocerciasis control programme, a high prevalence of epilepsy is observed. Both onchocerciasis and epilepsy are stigmatizing conditions. The first international workshop on onchocerciasis-associated epilepsy (OAE) was held in Antwerp, Belgium (12-14 October 2017) and during this meeting, an OAE alliance was established. In this paper, we review what is known about epilepsy-associated stigma in onchocerciasis-endemic regions, and present the recommendations of the OAE alliance working group on stigma. MAIN BODY: For this scoping review, literature searches were performed on the electronic databases PubMed, Scopus and Science Direct using the search terms "epilepsy AND onchocerciasis AND stigma". Hand searches were also undertaken using Google Scholar, and in total seven papers were identified that addressed epilepsy-related stigma in an onchocercisasis-endemic area. Due to the limited number of published research papers on epilepsy-associated stigma in onchocerciasis-endemic areas, other relevant literature that describes important aspects related to stigma is discussed. The thematic presentation of this scoping review follows key insights on the barriers to alleviating the social consequences of stigma in highly affected onchocerciasis-endemic areas, which were established by experts during the working group on stigma and discrimination at the first international workshop on OAE. These themes are: knowledge gaps, perceived disease aetiology, access to education, marriage restrictions, psycho-social well-being, burden on the care-giver and treatment seeking behaviour. Based on the literature and expert discussions during the OAE working group on stigma, this paper describes important issues regarding epilepsy-related stigma in onchocerciasis-endemic regions and recommends interventions that are needed to reduce stigma and discrimination for the improvement of the psycho-social well-being of persons with epilepsy. CONCLUSIONS: Educating healthcare workers and communities about OAE, strengthening onchocerciasis elimination programs, decreasing the anti-epileptic treatment gap, improving the care of epilepsy-related injuries, and prioritising epilepsy research is the way forward to decreasing the stigma associated with epilepsy in onchocerciasis-endemic regions.


Assuntos
Epilepsia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Estigma Social , Comitês Consultivos , África/epidemiologia , Bélgica , Cuidadores , Doenças Endêmicas , Epilepsia/complicações , Epilepsia/epidemiologia , Humanos , Oncocercose/complicações , Oncocercose/epidemiologia
8.
Biol Psychol ; 145: 211-223, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31129312

RESUMO

How emotions unfold through time in the brain, and how fast they can be regulated by voluntary control, remain unresolved. Psychological accounts of emotion regulation posit cognitive reappraisal mechanisms may alter early emotion generative processes directly, whereas suppression impacts only later processing stages, after emotion has arisen. However, to date, there is no neurophysiological data concerning the precise latency of emotion regulation effects on the amygdala, a major emotion processing relay in the brain. Here we record amygdala activity from six patients undergoing surgery for pharmaco-resistant epilepsy during both reappraisal and suppression. We find that emotion reappraisal strategy, but not suppression, modulates early neural responses to emotional scenes during an extended period of time, starting 130 ms post-stimulus onset. Further, reappraisal produced earlier impact on amygdala responses to positive compared to negative scenes. Our results provide the first neurophysiological support for theoretical accounts of emotion regulation that postulate an early modulation of emotion generative processes by reappraisal.


Assuntos
Tonsila do Cerebelo/fisiologia , Emoções/fisiologia , Adulto , Tonsila do Cerebelo/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Mapeamento Encefálico , Epilepsia/diagnóstico por imagem , Epilepsia/fisiopatologia , Epilepsia/psicologia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade
9.
J Clin Nurs ; 28(17-18): 3279-3287, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31063655

RESUMO

AIMS AND OBJECTIVES: To adapt the CONNECT Instrument for use in the paediatric population, to assess validity of this instrument after its adaptation and to assess concordance between mothers' perception of their child's illness and providers' understanding of mothers' perceptions. BACKGROUND: The CONNECT Instrument (Patient Education and Counseling, 73, 2008, 232-239) was validated in an adult outpatient population to characterise both patients' perspectives and physicians' understanding of their patients' perspectives for several dimensions of the illness experience. However, this did not include the paediatric population or advanced practice providers. DESIGN: A two-part prospective, cross-sectional, observational study to assess the validity of CONNECT for Pediatrics and to assess perception of illness. METHODS: The CONNECT Instrument (Patient Version) was adapted from its original form and modified to CONNECT for Pediatrics to facilitate use in the inpatient paediatric population. Eighty-five participants were enrolled including mothers, advanced practice providers and physicians from 2013-2014 during a child's scheduled admission to a paediatric epilepsy monitoring unit. Principal components analysis and inter-item reliability were analysed, and differences in the six mean domain scores were assessed using repeated measures analysis of variance (RM-ANOVA). Reporting of this research adheres to the STROBE guidelines (See Appendix S1). RESULTS: Our analysis indicated that the modifications made provided a relatively valid and reliable instrument. There were overall statistically significant differences between the mother and physician groups, specifically in the domains of meaning and preference for partnership. CONCLUSIONS: Paediatric advanced practice providers and physicians do have an understanding of mothers' perception of illness. RELEVANCE TO CLINICAL PRACTICE: The ability of physicians and advanced practice providers to understand mothers' perceptions of illness is increasingly important in a changing healthcare environment. CONNECT for Pediatrics facilitates the identification of mothers' perception of their child's illness and provides the opportunity for paediatric advanced practice providers and physicians to understand parents' perception of illness.


Assuntos
Atitude Frente a Saúde , Epilepsia/psicologia , Mães/psicologia , Inquéritos e Questionários/normas , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Percepção , Estudos Prospectivos , Reprodutibilidade dos Testes
10.
Acta Neurol Scand ; 140(1): 48-55, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30953593

RESUMO

INTRODUCTION: Aggressive behavior is commonly associated with epilepsy and can be influenced by the antiepileptic drugs (AEDs) taken. Sodium channel blockers, specifically the carboxamides derivatives such as carbamazepine and oxcarbazepine, are some of the AEDs considered to have a favorable psychiatric effect profile. OBJECTIVES: We aimed to assess whether the carboxamide analogue eslicarbazepine acetate (ESL) has any effect on the levels of anger in patients with epilepsy. MATERIAL AND METHODS: We prospectively recruited adult patients with epilepsy on treatment with ≦2 active AEDs, who required AED addition or substitution, excluding patients with active psychiatric disorders. All patients completed anger level (STAXI-2), depression-anxiety (HADS), and quality of life (QOLIE-10) assessments, and were evaluated at baseline and within 3-6 months after treatment initiation. RESULTS: Of 78 patients receiving ESL, as add-on therapy or in substitution of a previous AED, were recruited into the ESL group, with an average age of 48 years and 54% men. We used a control group of 58 patients receiving AEDs other than carboxamides. CONCLUSIONS: Patients overall showed improvements in anger levels, mood, and quality of life during the follow-up. A history of psychiatric disorders was a limiting factor to improve anger levels. As compared to controls, anger levels improved in ESL patients independently from seizure control. Therefore, ESL seems to exert a favorable influence on the anger levels of otherwise healthy patients with epilepsy, including those unresponsive to seizure control. The potential ESL anti-aggressive effect should be studied in patients with epilepsy and active psychiatric disorders.


Assuntos
Ira/efeitos dos fármacos , Anticonvulsivantes/uso terapêutico , Dibenzazepinas/uso terapêutico , Epilepsia/tratamento farmacológico , Epilepsia/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Bloqueadores dos Canais de Sódio/uso terapêutico
11.
Acta Neurol Scand ; 140(2): 87-92, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31002402

RESUMO

OBJECTIVE: To assess maternal and paternal stress in two groups of children with different types of epilepsy, at the time of diagnosis and after one year of follow-up. METHODS: We investigated parental stress in a sample of 85 children aged between 2 and 14 years, divided into two groups based on the diagnosis: Group 1 (50 patients) with childhood absence epilepsy or idiopathic focal epilepsy with rolandic discharges and Group 2 (35 patients) with different forms of drug-resistant epilepsy. Parents independently completed the Parental Stress Index-Short Form at Time 0, when they received the diagnosis and patients started therapy, and at Time 1, after 1 year of follow-up. RESULTS: We found high levels of stress in both mothers and fathers at Time 0, without statistically significant differences between the two groups. At Time 1, stress values were unchanged in Group 1 mothers; conversely, the levels of stress in Group 1 fathers reduced, with average values that all fell within the "normal range." In Group 2, stress levels were reduced both in mothers and in fathers at Time 1, compared to Time 0, but equally fell into the "pathological range," for both parents. CONCLUSION: In our study, the diagnosis of the epilepsy itself tended to increase parental stress, apparently regardless of the severity of the epilepsy; even after a period of follow-up, when the epilepsy was better controlled, overall parental stress remained high. It might have been related to feelings of parental inadequacy or concerns about issues such as safety or the outcome for the child.


Assuntos
Epilepsia/psicologia , Pais/psicologia , Estresse Psicológico/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Emoções , Feminino , Humanos , Masculino , Estresse Psicológico/epidemiologia , Inquéritos e Questionários
12.
Acta Neurol Scand ; 140(1): 40-47, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30963535

RESUMO

OBJECTIVES: For most people with epilepsy (PWE), problems that are not directly related to seizures may constitute major challenges in everyday life. The purpose of this study was to determine the extent of these challenges and any risk factors for their occurrence among PWE in Norway, based on the patients' own perspective. MATERIALS AND METHODS: We used a web-based survey to ask PWE visiting the homepage of the Norwegian Epilepsy Association about different everyday challenges. A link to the survey was accessible via the members' homepage for a 4-month period during 2017. RESULTS: One thousand one hundred eighty-two PWE responded to the questionnaire. Although more than 40% of the cohort reported that they had been seizure free for at least 1 year, the majority reported that tiredness (71%), memory problems (70%), concentration problems (68%), headache or vertigo (51%), and feeling depressed (59%) continued to represent challenges. In addition, fear of being alone, sexual problems or difficulties in social settings were reported by about one-third of the patients. Reporting having these challenges was significantly associated with female gender, polytherapy, experiencing seizures during the previous 12 months and feeling blue or depressed. CONCLUSIONS: The results of this study, reflecting a self-selected Norwegian population, provide insights into the challenges not directly associated with seizures that impact on the quality of life of PWE. The impacts of such challenges may be underestimated as components of the entire burden of epilepsy.


Assuntos
Epilepsia/complicações , Epilepsia/psicologia , Adolescente , Adulto , Depressão/etiologia , Fadiga/etiologia , Feminino , Cefaleia/etiologia , Humanos , Masculino , Transtornos da Memória/etiologia , Pessoa de Meia-Idade , Noruega , Qualidade de Vida , Inquéritos e Questionários , Vertigem/etiologia
13.
Seizure ; 67: 86-90, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30922778

RESUMO

PURPOSE: MEF2C-related epilepsy has been poorly described in the literature, despite a consistent MEF2C haploinsufficiency phenotype characterized by severe language impairment and motor delay (MIM# 613443). We aimed to delineate the spectrum of electroclinical manifestations of MEF2C-related epilepsy from an illustrative case and literature review. METHODS: A retrospective chart review of our case was performed followed by a literature review on PubMed and OMIM. Publications including patients with MEF2C pathogenic, likely pathogenic variants, or microdeletions without involvement of other genes were selected. RESULTS: The index case is a 2-year-old male with global developmental delay who presented at 7 months with atypical febrile seizures, generalized myoclonias, and focal impaired awareness seizures. Neuroimaging studies were unremarkable and electroencephalograms showed high voltage 200-400uV, 2-2.5 Hz generalized spike-and-waves and polyspikes with alternating frontal predominance, and multifocal spike-and-slow waves. Whole exome sequencing showed an unreported de novo likely pathogenic variant in the MEF2C gene c.236 G > C (p.Arg79Pro). Data from ten additional publications including 22 patients were gathered. From the 23 patients in total, 19 (82%) had seizures. Febrile seizures were most common, but myoclonic, focal-onset and generalized seizures were also reported. Electroencephalogram findings were described in eleven, and nine (82%) showed epileptiform abnormalities. CONCLUSION: MEF2C-related epilepsy may be described as a spectrum of manifestations including febrile seizures, myoclonia, and focal-onset or generalized seizures. Electroencephalogram is consistently abnormal, showing findings such as background slowing, multifocal and generalized epileptiform discharges and polyspikes. It remains unclear whether most patients are responsive or refractory to treatment with anti-epileptic medications.


Assuntos
Epilepsia/genética , Mutação , Encéfalo/fisiopatologia , Pré-Escolar , Epilepsia/fisiopatologia , Epilepsia/psicologia , Epilepsia/terapia , Humanos , Fatores de Transcrição MEF2/genética , Masculino , Fenótipo
14.
Br J Nurs ; 28(6): 348-354, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30925235

RESUMO

AIM:: this study examined a brief lifestyle self-management intervention, based on self-determination theory, to manage seizure frequency, and its effects on health-related quality of life and resilience in people with epilepsy aged over 18 years. BACKGROUND:: most people with epilepsy can identify factors that may trigger seizures and may try to avoid these; however, education from clinicians on this varies. DESIGN:: a cohort study with control design. METHOD:: sixty participants were purposively sampled and allocated to an intervention or a control group. RESULTS:: moderate correlations were found, particularly between: resilience and satisfaction with life; medication adherence and psychological quality of life; and psychological quality of life and satisfaction with life. The mean seizure occurrences between the control and intervention groups were 12.71 (SD 24.55) and 6.76 (SD 13.40) respectively after the intervention. While the study was not powered to assess this, the intervention may be most effective regarding medication adherence and physical health quality of life. CONCLUSION:: the relationship between self-efficacy and seizure management appeared to be strengthened by the programme. This study is the first known to measure resilience in relation to lifestyle self-management for seizure control in people with epilepsy. Relevance to practice: nurses are well placed to work with patients' strengths towards self-efficacy and potentially resilient coping.


Assuntos
Epilepsia/psicologia , Educação de Pacientes como Assunto , Adolescente , Adulto , Estudos de Coortes , Epilepsia/enfermagem , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Autogestão , Resultado do Tratamento , Adulto Jovem
15.
Epilepsy Res ; 153: 68-70, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30850259

RESUMO

Controlled clinical trials in adults with medically intractable focal seizures treated with the RNS® System demonstrate that closed-loop responsive neurostimulation to the seizure focus reduces the frequency of disabling seizures, is well tolerated, and is acceptably safe. Seizure reductions begin with initiation of treatment and continue over time, reaching median reductions of 75% after 9 years of treatment. Treatment with responsive cortical stimulation is also associated with improvement in quality of life and cognitive function related to the functional area being treated. In addition, the RNS System's chronic ambulatory electrocorticographic monitoring provides unprecedented insight into each patient's disease management, and into the study of epilepsy itself, in ways that may enhance the treatment of epilepsy in the future.


Assuntos
Encéfalo/fisiologia , Estimulação Encefálica Profunda/métodos , Epilepsia/terapia , Neuroestimuladores Implantáveis , Animais , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/terapia , Epilepsia Resistente a Medicamentos/terapia , Eletrodos Implantados , Eletroencefalografia , Epilepsia/complicações , Epilepsia/psicologia , Humanos , Qualidade de Vida
16.
Seizure ; 67: 23-26, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30856458

RESUMO

PURPOSE: To describe sociocultural representations of epilepsy in a sub-Saharan Africa rural community using a population-based approach. METHOD: A cross-sectional door-to-door survey was underway on a rural community of the Central African Republic in 2015. A two-stage stratified sampling was performed. Trained care personnel performed individual face-to-face interviews. A standardized questionnaire was used to assess epilepsy. We collected sociodemographic data and cultural representations toward epilepsy in general population. RESULTS: Overall, 1023 participants were interviewed. Epilepsy prevalence was 11.7 (95%CI 6.7-20.4) per 1000 people. In the rural community, epilepsy was identified as a supernatural disease related to bad luck (40.4%), witchcraft (31.3%) or a curse (28.3%). Epilepsy was confused with a mental disorder in 75.9% of subjects. Three quarters of participants (75.3%) considered epilepsy as a contagious disease. Saliva was mainly mentioned as a means of transmission in 63.8%. More than half of participants preferred or recommended traditional treatments. Only 24.8% believed in the efficacy of medical treatment for epilepsy. CONCLUSIONS: Epilepsy misconceptions are highly prevalent in rural sub-Saharan Africa. Understanding misrepresentations is an essential phase to develop culturally appropriate interventional programs in order to improve medical treatment adherence, quality of life, and to decrease stigma. Campaigns to raise awareness are needed in urban and rural population to reduce misconception and combat stigmatization.


Assuntos
Epilepsia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Adolescente , Adulto , República Centro-Africana , Criança , Estudos Transversais , Cultura , Epilepsia/epidemiologia , Epilepsia/etnologia , Epilepsia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural , Estigma Social , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
17.
Seizure ; 67: 1-4, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826629

RESUMO

PURPOSE: Using specialized tools, we assessed patients receiving perampanel (PER) to investigate its effects on aggression and depression, as well as the impact of other concomitant antiepileptic drugs (AEDs) on those conditions. METHOD: Seventy-seven patients with epilepsy were initially enrolled, then examined at entry and 12 weeks later (endpoint). At both examinations, assessments were performed with the Buss Perry Aggression Questionnaire (BAQ) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Ultimately, 59 patients completed the study. RESULTS: Total BAQ (p = 0.013) and NDDI-E (p = 0.000) scores at the endpoint were significantly increased in comparison with those at entry. Analysis with 4 subscales showed increases in both verbal and physical aggression, while multivariate analysis revealed that concomitant AED administration did not have a significant impact on the increase of BAQ or NDDI-E score. A dose-dependent effect of PER was confirmed in BAQ, but not NDDI-E results. PER was discontinued due to adverse psychiatric effects in 3.9% of the patients. CONCLUSIONS: The present findings indicate that PER increases assessment scores indicative of aggression as well as depression. No additional aggression-augmenting effect was seen with concomitant AED administration.


Assuntos
Agressão/efeitos dos fármacos , Anticonvulsivantes/efeitos adversos , Depressão/induzido quimicamente , Epilepsia/tratamento farmacológico , Piridonas/efeitos adversos , Adolescente , Adulto , Idoso , Anticonvulsivantes/uso terapêutico , Relação Dose-Resposta a Droga , Epilepsia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Piridonas/uso terapêutico , Resultado do Tratamento , Adulto Jovem
18.
Acta Neurol Scand ; 139(6): 519-525, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30820944

RESUMO

OBJECTIVE: Depression and anxiety symptoms are common among patients with epilepsy, but are relatively under-researched in patients with both epilepsy and intellectual disability (ID). The aim was to investigate whether epilepsy and ID characteristics are associated with mood, anxiety, and quality of life. MATERIALS AND METHODS: Adult patients with epilepsy and ID who rely on tertiary epilepsy care were included (N = 189). Mood, anxiety, and quality of life were assessed by standardized questionnaires. Epilepsy and ID characteristics were retrieved from patient charts or determined by psychometric instruments. RESULTS: Elevated levels of depressive and anxiety symptoms were present in 21.7% and 12.7%, respectively. Anxiety was significantly associated with a focal epilepsy type and ID domain discrepancy (substantial difference between two domains of adaptive behavior), but was negatively related to seizure frequency and drug load of mood-stabilizing antiepileptic drugs. Depressive symptoms were not significantly related to epilepsy characteristics, but a severe ID and ID domain discrepancy was associated with more depressive symptoms. Quality of life was significantly worse in those with multiple seizure types and ID domain discrepancy. CONCLUSION: Whereas anxiety and quality of life are associated with individual epilepsy characteristics, this could not be confirmed for depressive symptoms in patients with epilepsy and ID, despite its high prevalence.


Assuntos
Epilepsia/complicações , Epilepsia/psicologia , Deficiência Intelectual/complicações , Deficiência Intelectual/psicologia , Qualidade de Vida/psicologia , Adulto , Afeto , Idoso , Anticonvulsivantes/uso terapêutico , Ansiedade/epidemiologia , Ansiedade/psicologia , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
19.
Seizure ; 66: 86-92, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30818182

RESUMO

PURPOSE: To evaluate the prevalence, suicidality and treatment gap (TG) of depression in people with epilepsy (PWE) in West China, and to explore the related risk factors. METHODS: A consecutive cohort of PWE from West China Hospital was recruited. The Chinese version of the Neurological Disorders Depression Inventory for Epilepsy scale was used to assess depression and suicidality. Prevalence and TG of depression were calculated. Logistic regression analysis was used to assess risk factors of depression and suicidality. RESULTS: Among a total of 461 participants, there were 29.9% with depression and 15.8% had suicidality. Being female, an unmarried status, disease course, seizure frequency, seizure occurrence in the last 6 months, and focal impaired awareness seizure were risk factors for depression. Depression was an independent risk factor for suicidality. The TG of depression was 72.5%. The TG was larger in the 30-40 year age group, in rural populations, and among those with a disease course between 5 and 10 years. The TG figures dropped with increasing annual family income. CONCLUSIONS: The prevalence of depression and the rate of suicide risk for PWE in West China are high. A large TG for depression exists in PWE. Clinicians should focus on depression and suicidality for PWE and identify the related risk factors in a timely manner so as to reduce the incidence of depression and suicide. Management including public education as well as professional training of neurologists are necessary to fill the TG.


Assuntos
Depressão/epidemiologia , Epilepsia/epidemiologia , Suicídio/estatística & dados numéricos , Adolescente , Adulto , China/epidemiologia , Depressão/etiologia , Epilepsia/complicações , Epilepsia/psicologia , Epilepsia/terapia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Fatores de Risco , População Rural , Autorrelato , Adulto Jovem
20.
Seizure ; 66: 93-98, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30818183

RESUMO

PURPOSE: The purpose of the present study was to compare depression and QoL between patients with epilepsy and healthy controls, evaluating potentially related factors to depression and QoL in patients with epilepsy in Northwest Greece. METHODS: A case study was conducted in adult patients with epilepsy followed up at the University Hospital of Ioannina and in healthy controls. The Patient Health Questionnaire (PHQ-9) for depression's severity evaluation, the WHOQOL-BREF questionnaire for the QoL estimation and the Adverse Event Profile (AEP) questionnaire for the Antiepileptic Drugs (AEDs) adverse effects assessment were used. RESULTS: Seventy patients with epilepsy and 70 controls were recruited. The PHQ-9 score was higher in patients compared to controls and slightly higher than reported in patients with epilepsy. PHQ-9 was significantly associated with the AEP score. Our patients had a poorer QoL compared to controls. The level of education, the AEP and the PHQ-9 scores were associated to QoL, the last two being the most powerful predictors of QoL. CONCLUSION: Patients with epilepsy in Northwest Greece had higher rates of depression than reported in patients with epilepsy and poorer QoL compared to controls. The adverse effects of AEDs were related to depression in our study, while the adverse effects of AEDs and depression were more powerful predictors of QoL compared to demographics and other characteristics of epilepsy.


Assuntos
Depressão/epidemiologia , Epilepsia , Qualidade de Vida/psicologia , Adulto , Anticonvulsivantes , Depressão/etiologia , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Epilepsia/psicologia , Feminino , Grécia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Adulto Jovem
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