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1.
Epilepsy Behav ; 137(Pt A): 108949, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36327643

RESUMO

OBJECTIVE: This survey aimed to investigate the opinions of the parents of children with epilepsy with regard to the application of epilepsy surgery for their children. METHODS: We surveyed all the parents of children with epilepsy referred to our neurology clinic (Shiraz University of Medical Sciences) in April-July 2022. We collected their opinions about epilepsy surgery based on a predesigned questionnaire. The inclusion criteria included parents of all children with epilepsy (1 to 16 years of age, with at least one-year history of epilepsy, and with at least one drug used in the past 12 months). RESULTS: In total, 472 people participated in the study; 277 participants (58.7%) were willing to have epilepsy surgery for their child; the most common reason was to be able to discontinue the drugs. Sex (male), age (younger), and education (college) of the parents had significant associations with the parental willingness to have surgery for their children. The patient's drug regimen (polytherapy) and history of ictal injury (in the child) also had significant associations with the parental willingness to have surgery for the children. CONCLUSION: Most parents of children with epilepsy are willing to have epilepsy surgery for their children if their physician presents epilepsy surgery to them as an established, safe, and effective treatment option. Patient and parental-related factors should be considered when designing educational materials and programs for preoperative counseling for the parents of children with drug-resistant seizures.


Assuntos
Epilepsia , Criança , Masculino , Humanos , Lactente , Epilepsia/psicologia , Pais/psicologia , Inquéritos e Questionários , Família , Resultado do Tratamento
2.
Seizure ; 102: 83-95, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36209677

RESUMO

RATIONALE: Up to 40% of pediatric epilepsy cases are drug-resistant and associated with neurocognitive, psychosocial, developmental comorbidities, and risk of early mortality. Epilepsy surgery (ES) may be considered after the failure of two anti-seizure medications (ASM) to provide patients with the opportunity to attain seizure freedom. However, only a small proportion of eligible patients receive surgical treatment. This scoping review aims to elucidate barriers to pediatric ES to understand the reasons for its underutilization. METHODS: Embase, PubMed, and Scopus were searched from inception through August 2022 for the following PICO terms: "pediatric", "parents", "epilepsy", "surgery", and "decision-making". Studies exploring barriers to ES were included and qualitatively synthesized. We adopted an inductive thematical approach, and barriers hindering ES were assigned to four thematic categories. PRISMA Sc-R guidelines were followed. RESULTS: Of 3400 retrieved studies, 17 were included. Barriers to ES were classified into 4 categories. Parental barriers originating from misperception, lack of knowledge regarding surgical outcomes, and emotional vulnerability were highlighted in 76% of included studies. Physician-based barriers, including lack of clinical expertise, trust, and communication, leading to inadequate informed consent and referral to surgical evaluation, were described in 65% of articles. Patient-based barriers were reported in 47% of studies and included clinical characteristics modulating acceptance of ES. Only 18% of studies described healthcare system-based barriers, including intricate insurance policies not adapted to sociodemographic disparities. CONCLUSION: This study highlights the complexity of barriers to pediatric ES. Our findings emphasize the need for multileveled strategies to increase the utilization of ES among eligible pediatric patients.


Assuntos
Epilepsia , Médicos , Humanos , Comunicação , Epilepsia/cirurgia , Epilepsia/psicologia , Pais/psicologia , Encaminhamento e Consulta
3.
Epilepsy Res ; 187: 107031, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36242950

RESUMO

BACKGROUND: Patients with epilepsy are at increased risk of suicide which is often preceded by suicidal ideation. Suicidal ideation is rarely assessed in Nigerian patients with epilepsy and there are limited studies on prevalence and determinants. METHODS: Two-hundred and seventy patients with epilepsy attending the Neuropsychiatric Hospital, Abeokuta were recruited. Suicidal ideation was assessed with item 9 of the BDI-II. QOLIE-31, MINI-PLUS, and a sociodemographic questionnaire were also administered to the participants. RESULTS: Twenty-four patients reported having suicidal ideation with a prevalence of 8.9 %. Suicidal patients were younger, more likely to have a current or history of a mood disorder, and had a lower quality of life scores on all domains. In the multivariate analysis, current major depression (OR=26.26, p < 0.0001, CI= 8.51 - 81.05) and a lower score on the cognitive functioning subscale of the QOLIE-31 (OR=0.97, p = 0.003, CI=0.96 - 0.99) were the only independent predictors of suicidal ideation. CONCLUSIONS: Suicidal ideation is common among Nigerian patients with epilepsy. Comorbid depression and poor cognitive functioning are risk factors for suicidal ideation among them. Clinicians should screen for suicidal ideation and comorbid mood disorders among patients with epilepsy and identify patients at increased risk of suicide.


Assuntos
Epilepsia , Suicídio , Humanos , Ideação Suicida , Qualidade de Vida/psicologia , Nigéria/epidemiologia , Suicídio/psicologia , Epilepsia/epidemiologia , Epilepsia/psicologia , Fatores de Risco
4.
Epilepsy Behav ; 137(Pt A): 108921, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36283291

RESUMO

Stigma is perhaps the most important sociopsychological burden for people with epilepsy (PWE), and literature both reflects and influences societal attitudes including stigma. To study how representations of stigma have changed over time could provide interesting insights. Traditionally, often repeated stigmatizing aspects include possession, insanity and crime, the weak, dependent and miserable epileptic, unfitness for marriage and reproduction, unreliability, but also special gifts. Many works present characters with epilepsy as inferior, outsiders, or misers. Recently, however, changes became apparent. First, several books addressed and criticized stigmatization of PWE. This was followed by works with positive characters, even role models, both women and men. They are independent, competent, sexually active, and attractive. Some indulge in sports, arts, or advanced technologies. Several are based on first-hand knowledge of people with epilepsy, and some belong to the field of autofiction. Optimistic literary categories like romance or coming-of-age are increasingly met, often with a first-person narrator. Whereas traditional epilepsy metaphors often indicate vulnerability, emotional instability, and weirdness, newer literature increasingly uses electricity metaphors. These represent power, excitement, and modernity. Another frequent new destigmatizing feature are olfactory auras that create a positive atmosphere. Along with comparable destigmatizing features in present popular music, recent developments in literature may represent a parallel to an emerging change in public opinions on epilepsy to which they could contribute an emotional dimension.


Assuntos
Epilepsia , Estigma Social , Masculino , Feminino , Humanos , Epilepsia/psicologia , Estereotipagem , Opinião Pública , Casamento
5.
Arq Neuropsiquiatr ; 80(7): 718-724, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-36254445

RESUMO

BACKGROUND: It is known that the risk of suicidal behavior in adult people with epilepsy (PWEs) is high. However, the associated clinical and psychosocial factors are still being discussed. OBJECTIVE: To assess the risk of suicide in PWEs and relate it to resilience and quality of life (QoL) as well as with clinical variables. METHODS: The item "I'd be better off dead" of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was related to the resilience scale, clinical aspects, the presence of depression, and the Quality of Life in Epilepsy Inventory (QOLIE-31) scores of PWEs, with a p < 0.05. RESULTS: A total of 271 PWEs were assessed, 50.6% were female, with a mean age of 46.6 (± 15.8) years, and a mean age at 1st seizure of 24.1 (± 18.5) years. Risk for suicide occurred in 50 (19.3%) cases. In multiple logistic regression, the factors that explain the risk of suicide were female sex, depression, and lower scores on the QOLIE-31 and on the resilience scale. In the classification and regression trees, the order of importance of the variables was depression > resilience > age > QoL > age at 1st seizure. CONCLUSION: The risk of suicide was high, and it was associated with demographic aspects, clinical variables, QoL, and resilience. A higher risk of suicide was associated with lower resilience regardless of the presence or absence of depression. In the presence of depression, a higher risk of suicide was associated with the early onset of epilepsy. In the absence of depression, the risk of suicide was associated with low QoL in young adults.


ANTECEDENTES: É sabido que o risco de comportamento suicida é elevado em pessoas adultas com epilepsia (PCEs); entretanto, ainda são discutidos quais são os fatores clínicos e psicossociais associados. OBJETIVO: Avaliar o risco de suicídio em PCEs e relacioná-lo com a resiliência e a qualidade de vida (QV) e com as variáveis clínicas. MéTODOS: Foi relacionado o item ­ "Eu preferiria estar morto" do inventário de depressão em transtornos neurológicos para a epilepsia (IDTN-E) com a escala de resiliência, os aspectos clínicos, a presença de depressão e com o inventário de qualidade de vida na epilepsia (QOLIE-31) de PCEs, com p < 0.05. RESULTADOS: Foram avaliados 271 PCEs, 50.6% dos quais eram do sexo feminino. A idade média foi de 46.6 (± 15.8) anos, e idade na 1ª crise 24.1 (± 18.5) anos. O risco de suicídio ocorreu em 50 (19.3%) casos. Na regressão logística múltipla, os fatores que explicaram o maior risco de suicídio foram o sexo feminino, a depressão, e os menores escores no QOLIE­31 e na escala de resiliência. Na árvore de classificação e regressão, a ordem de importância das variáveis foi depressão > resiliência > idade > QV > idade na 1ª crise. CONCLUSãO: O risco de suicídio foi elevado e associou-se com aspectos demográficos, variáveis clínicas, a QV e a resiliência. O maior risco de suicídio associou-se à menor resiliência, independente da presença de depressão. Na presença de depressão, o maior risco de suicídio associou-se ao início precoce da epilepsia. Na ausência de depressão, o risco de suicídio associou-se à baixa QV em adultos jovens.


Assuntos
Epilepsia , Ideação Suicida , Adolescente , Adulto , Criança , Pré-Escolar , Depressão/psicologia , Epilepsia/psicologia , Humanos , Lactente , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Convulsões/complicações , Adulto Jovem
6.
Seizure ; 102: 129-133, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36240699

RESUMO

PURPOSE: Cenobamate (CNB) is a new antiseizure medication (ASM) for the treatment of focal epilepsy in adults. While efficacy of CNB was confirmed in controlled clinical trials, its effects on cognition are unclear. Cognitive adverse effects of ASM affect quality of life and retention rate. Therefore, we investigated whether the adjunctive treatment with CNB is associated with changes in cognitive performance. METHOD: Efficacy and tolerability of CNB were investigated in an observational study. Fifty patients with pharmacoresistant focal epilepsy aged 18 to 71 years (Mdn = 37.5 years) were tested before (T0) and after reaching the first target dose of CNB, usually after three months (T1). Cognitive performance was assessed using the EpiTrack©, a change-sensitive screening tool for attention and executive functions. RESULTS: The median CNB dose at T1 was 125 mg/day (range: 50 - 250 mg/day). Most patients received 2-3 concomitant ASMs. Individual test scores remained stable in 72%, significantly improved in 16%, and significantly deteriorated in 12% of the patients from T0 to T1. The total group showed a significant improvement in EpiTrack scores (p < .01). Changes in EpiTrack performance from T0 to T1 occurred independently of CNB dose, changes in the total drug load or reduction in seizure frequency. CONCLUSION: Most of the patients showed stable or improved cognitive performance. Thus, there is preliminary evidence that adjunctive CNB is not associated with an increased risk of cognitive side effects for the majority of patients. These findings need to be confirmed in controlled trials encompassing higher doses.


Assuntos
Epilepsias Parciais , Epilepsia , Adulto , Humanos , Anticonvulsivantes/efeitos adversos , Qualidade de Vida , Epilepsia/psicologia , Epilepsias Parciais/tratamento farmacológico , Cognição , Resultado do Tratamento , Quimioterapia Combinada
7.
Seizure ; 103: 3-10, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36244183

RESUMO

OBJECTIVE: The aim of this population-based, cross-sectional study was to describe caregiver-reported seizure precipitants, measures taken to prevent seizures and rescue therapies in children with Dravet Syndrome (DS). METHODS: In a population-based study, caregivers of 42/48 Swedish children with DS born between 2000 and 2018 were interviewed. Frequency of precipitants, preventive measures, and rescue therapies were compared between children born 2000-2009 and 2010-2018 and between `severe´ and `less severe´ epilepsy. RESULTS: All children had experienced precipitants. Preventive measures were employed in all. Seizures had been provoked by a median of seven (range 2-11) out of 13 factors. A median of eight (range 1-17) preventive measures out of 19 were reported. The most common precipitants were fever (n=42, 100%), and afebrile infections (n=39/42, 93%). Afebrile infections (p=0.014) and reduced ambient temperature (p=0.006) were more common precipitants in younger children, and bright light in children with severe epilepsy (p=0.013). The most common factors avoided were warm weather (n=35/42, 83%) and physical activity (n=27/42, 64%). It was more common to avoid strong emotions (p=0.035) and reduced temperature (p=0.002) in younger children, and to avoid infections (p=0.024) and crowds (p=0.046) in children with 'severe' epilepsy. Many children (n=28/42, 67%) or their siblings (n=16/34, 47% of individuals with siblings) had stayed home to avoid infections in school/day-care. Use of emergency medicines was more frequent in younger children (p=0.006) and in children with 'severe' epilepsy (p=0.007). SIGNIFICANCE: Caregiver-reported seizure precipitants are common in DS. Caregivers employ a range of measures to avoid seizures, restricting family life.


Assuntos
Epilepsias Mioclônicas , Epilepsia , Criança , Humanos , Cuidadores , Estudos Transversais , Convulsões/prevenção & controle , Convulsões/psicologia , Epilepsias Mioclônicas/complicações , Epilepsia/complicações , Epilepsia/psicologia
8.
Behav Neurol ; 2022: 1142215, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36134035

RESUMO

Acceptance of illness is regarded as an indicator of functioning and predictor of quality of life. However, quality of life of patients with epilepsy in sub-Saharan countries worsen because of low medication adherence, increased morbidity and mortality, and the stigmatization associated with the disease. This research is aimed at assessing the level of acceptance of illness of patients with epilepsy and associated quality of life in North-East Ethiopia. Methods. A cross-sectional study was conducted from January to June 2021 at the Debre Berhan Referral Hospital, North-East Ethiopia. A total of 78 patients with epilepsy aged more than 18 years were randomly selected and assessed using Quality of Life in Epilepsy Inventory 31 and acceptance of illness scale. In addition, authors owned questionnaire were used to evaluate the sociodemographic and clinical characteristics of the patients. P value < 0.05 at 95% confidence level was considered to be statistically significant in all the analysis. Result. The study participants' age varied between 18 and 67 years with the mean age of 28.9 years. Phenobarbital was the most used (73.9%) antiepileptic drug, and 68.7% (n = 66) of the patients seizure was controlled. 72.9% (n = 70) of the patients had medium acceptance of illness (scored 20-30), while 17.7% (n = 17) had low illness acceptance level (scored 8-19), and 9.4% (n = 9) had high acceptance of illness (scored 31-40). The mean of overall acceptance of illness among epileptic patients was 21.04 ± 7.21. The overall score of QOLIE-31 was 79.14 ± 25.46, and the highest mean score was for cognitive (83.5 ± 27.1), while the lowest mean score was that of medication effect (72.7 ± 28.7). Five of the seven QOLIE-31 components correlated significantly with level of acceptance of illness. Cognitive domain (r = 0.498, p < 0.001) demonstrated the highest correlation followed by overall quality of life (r = 0.489, p < 0.001), seizure worry (r = 0.433, p < 0.001), energy/fatigue (r = 0.342, p < 0.001), and emotional well-being (r = 0.278, p < 0.001). Conclusion. Patients with epilepsy in the study area had medium acceptance of illness, and nearly half of them had mean and more than the mean quality of life. The patients' acceptance of illness was significantly associated with overall quality of life, seizure worry, emotional well-being, and cognitive domain of the patients.


Assuntos
Epilepsia , Qualidade de Vida , Adulto , Anticonvulsivantes/uso terapêutico , Estudos Transversais , Epilepsia/psicologia , Etiópia , Humanos , Fenobarbital , Qualidade de Vida/psicologia , Convulsões/tratamento farmacológico , Inquéritos e Questionários
9.
Front Public Health ; 10: 952585, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36091545

RESUMO

Purpose: Epilepsy is one of the most common neurological disorders with high costs for the healthcare systems and great suffering for patients. Beyond seizures, psychosocial comorbidities can have detrimental effects on the well-being of people with epilepsy. One source of social stress and reduced quality of life is epilepsy-related stigma that often occurs, e.g., due to public misconceptions or myths. Stigma has individual biological, psychological and social correlates. Moreover, environmental factors like living in remote areas are associated with stigma. However, little is known about the link between the social structure of the residence and stigma in epilepsy. Thus, we investigated the association between the structural socioeconomic status (SES) and perceived stigma in an urban epilepsy population. Methods: This prospective, cross-sectional study examined 226 adult in-patients with epilepsy from Berlin. Multiple regression analyses were performed to check the relationship between structural SES and stigma controlling for individual-level demographic, clinical, psychological and social factors. Continuous social indices (SI) of the districts and neighborhoods ("SI district" and "SI neighborhood") of Berlin were used to measure different levels of structural SES. Non-linear relationships are tested by grouping the SI in quartiles. Results: Both indicators of structural SES were independently linked to stigma (p = 0.002). For "SI district", we identified a non-linear relationship with patients from the most deprived quartile feeling less stigmatized compared to those in the second (p < 0.001) or least deprived quartile (p = 0.009). Furthermore, more restrictions of daily life (p < 0.001), unfavorable income (p = 0.009) and seizure freedom in the past 6 months (p = 0.05) were related to increased stigma. A lower "SI neighborhood" was associated with higher stigma (p = 0.002). Conclusion: Strategies to reduce epilepsy-related stigma need to consider the sociostructural living environment on different regional levels. Unfavorable relations with the immediate living environment may be directly targeted in patient-centered interventions. Non-linear associations with the structural SES of broader regional levels should be considered in public education programs. Further research is needed to examine possible underlying mechanisms and gain insight into the generalizability of our findings to other populations.


Assuntos
Epilepsia , Qualidade de Vida , Adulto , Estudos Transversais , Epilepsia/epidemiologia , Epilepsia/psicologia , Humanos , Estudos Prospectivos , Qualidade de Vida/psicologia , Classe Social
10.
Seizure ; 101: 244-252, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36116283

RESUMO

OBJECTIVE: To explore the cortical morphological associations of the psychoses of epilepsy. METHODS: Psychosis of epilepsy (POE) has two main subtypes - postictal psychosis and interictal psychosis. We used automated surface-based analysis of magnetic resonance images to compare cortical thickness, area, and volume across the whole brain between: (i) all patients with POE (n = 23) relative to epilepsy-without psychosis controls (EC; n = 23), (ii) patients with interictal psychosis (n = 10) or postictal psychosis (n = 13) relative to EC, and (iii) patients with postictal psychosis (n = 13) relative to patients with interictal psychosis (n = 10). RESULTS: POE is characterised by cortical thickening relative to EC, occurring primarily in nodes of the cognitive control network; (rostral anterior cingulate, caudal anterior cingulate, middle frontal gyrus), and the default mode network (posterior cingulate, medial paracentral gyrus, and precuneus). Patients with interictal psychosis displayed cortical thickening in the left hemisphere in occipital and temporal regions relative to EC (lateral occipital cortex, lingual, fusiform, and inferior temporal gyri), which was evident to a lesser extent in postictal psychosis patients. There were no significant differences in cortical thickness, area, or volume between the postictal psychosis and EC groups, or between the postictal psychosis and interictal psychosis groups. However, prior to correction for multiple comparisons, both the interictal psychosis and postictal psychosis groups displayed cortical thickening relative to EC in highly similar regions to those identified in the POE group overall. SIGNIFICANCE: The results show cortical thickening in POE overall, primarily in nodes of the cognitive control and default mode networks, compared to patients with epilepsy without psychosis. Additional thickening in temporal and occipital neocortex implicated in the dorsal and ventral visual pathways may differentiate interictal psychosis from postictal psychosis. A novel mechanism for cortical thickening in POE is proposed whereby normal synaptic pruning processes are interrupted by seizure onset.


Assuntos
Epilepsia , Transtornos Psicóticos , Cognição , Eletroencefalografia/métodos , Epilepsia/psicologia , Humanos , Imageamento por Ressonância Magnética/métodos , Transtornos Psicóticos/diagnóstico por imagem , Convulsões
11.
Epilepsy Behav ; 135: 108900, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36115083

RESUMO

PURPOSE: The worldwide pandemic caused by SARS-CoV-2 virus posed many challenges to the scientific and medical communities, including the protection and management of fragile populations. People with epilepsy (PWE) are a heterogenous group of subjects, with different treatment regimens and severity of symptoms. During the National lockdown, in Italy many patients with chronic conditions lost their regular follow-up program. The aim of this study was to investigate the impact of COVID-19 on their health status, from the start of the pandemic (March 2020) to July 2021 and one year later. METHODS: We proposed an online questionnaire to subjects followed up at different epilepsy centers located in Milano, Monza & Lodi, three of Lombardy, Northern Italy, the most affected areas by the pandemic. Survey evaluated age, sex, characteristics of patients, type of epilepsy and therapies, COVID-19 diagnosis, vaccines, sleep quality, and anxiety status. RESULTS: Among 178 analyzed surveys, 37 individuals reported symptoms of COVID-19 in closed contacts, including 9 with molecular diagnosis and 16 PWE performing the nasopharyngeal swab with 3 positive cases. One year later, 35 individuals reported at least one symptom overlapping with those typical of COVID-19, 8 received COVID-19 diagnosis, among which 6 were positive for SARS-CoV-2 infection. According to the sleep quality scale assessment, most PWE (52.3%) had poor sleep quality. Assessing anxiety status, 32 (38.1%) had a pathological score. CONCLUSION: In this multicenter study, we observed that PWE do not appear to be at a higher risk of severe COVID-19. It will be fundamental monitoring this group to assess possible differences in long-COVID-19 and/or neuro-COVID-19 prevalence. On the other hand, our survey confirmed the impact of the pandemic on anxiety and quality of sleep in PWE. Thus, it is important to promptly recognize and treat psychological distress in PWE, because it could be a risk factor in seizure aggravation and quality-of-life deterioration. Telemedicine appears to be a useful tool to support patients with chronic diseases, such as epilepsy.


Assuntos
COVID-19 , Epilepsia , COVID-19/complicações , COVID-19/epidemiologia , Teste para COVID-19 , Controle de Doenças Transmissíveis , Epilepsia/psicologia , Humanos , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
12.
Epilepsy Behav ; 136: 108912, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36150303

RESUMO

INTRODUCTION: The Internet and social media are becoming increasingly important medical information sources, bringing advantages and disadvantages. The extent of social media use may help to develop a strategy for providing relevant information, enhancing patients' social status, and the work of medical practitioners in chronic medical conditions such as epilepsy. AIM: The aim of this study was to help better understand the factors of social media that may affect patients' knowledge of the disease, health education, emotional stability, thinking, and decisions in the treatment process. MATERIAL AND METHODS: We studied the representation of epilepsy among social media users in Serbian, Croatian, and Bosnian languages. Our observational study analyzed 1000 randomized posts and videos on Facebook, Twitter, and YouTube, containing the keywords "epilepsy" or "seizure." Posts were divided into three categories: topics, data sources, and the nature of the engagement. RESULTS: The most common topic among social media users was the stigmatization of patients (31%). The most prevalent data source was support groups for PWE (45.4%). The nature of the engagement was most dominant on the occasion of the exchange of information, i.e., advice (40%). CONCLUSION: The participation of medical professionals on social media is not adequately represented in Serbian, Croatian, and Bosnian language platforms. The presence of medical professionals on social media could increase the credibility of the information available to users, educate patients, and reduce the prevalence of stigma.


Assuntos
Epilepsia , Mídias Sociais , Humanos , Idioma , Croácia/epidemiologia , Sérvia , Epilepsia/epidemiologia , Epilepsia/psicologia
13.
Epilepsy Behav ; 136: 108920, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36166878

RESUMO

BACKGROUND: The standard of care provided to patients with chronic epilepsy might be affected by clinical nurses' understanding, awareness, and attitudes toward the condition. The objective of this study was to assess the knowledge, awareness, and attitudes toward chronic epilepsy among clinical nurses in the Second Affiliated Hospital of Zhejiang University School of Medicine, China. METHODS: Two hundred and thirty-eight nurses from the neurosurgery, neurology, epilepsy center, other internal medicine and other surgery department working at our hospital participated in this descriptive and cross-sectional study in 2022. The data were collected through an electronic questionnaire, which comprised four domains including demographic and clinical epilepsy-related questions, awareness of epilepsy section, 18 items for knowledge and a 15-item scale for attitudes. Mann-Whitney U tests, Kruskal-Wallis H tests, post hoc analysis, Pearson correlation analysis, and descriptive statistics were used to analyze the non-normal distribution of the dataset. RESULTS: The clinical nurses' average score on the awareness of epilepsy section was 14.93 ± 2.69 (maximum score: 20), the knowledge of epilepsy section scored 15.41 ± 2.30 (maximum score: 18), and the epilepsy attitude section scored 30.65 ± 7.40. The knowledge and awareness accuracy of the responses to the epilepsy-related questions were positively and significantly correlated (r = 0.251, p < 0.001). The multiple linear regression model found that the department (p < 0.001) and rank (p = 0.015) of nurses were independently associated with awareness toward epilepsy. Meanwhile, there was a statistically significant difference between the departments of nurses and accuracy on the Epilepsy Knowledge Scale (H = 18.340, p < 0.001). In addition, 92.77% of nurses agreed that people with chronic epilepsy have the same rights as all people. Unfortunately, over 30% of nurses maintained an uncertain attitude toward the employment, marriage, and emotion related to epilepsy. CONCLUSION: Our findings revealed that nurses had a general awareness and understanding of epilepsy, attitudes toward epilepsy. Specifically, nurses working in the Neurology Department and the Epilepsy Center were predisposed to have a considerably better level of awareness and knowledge of epilepsy. Additionally, as their understanding of epilepsy grew, so did their sensitivity to those who suffer from the condition. The study also recommends that epilepsy experts deliver additional lectures and training sessions to enhance nurses' knowledge of first-aid for seizures.


Assuntos
Epilepsia , Enfermeiras e Enfermeiros , Humanos , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Competência Clínica , Epilepsia/psicologia , Inquéritos e Questionários , Atitude do Pessoal de Saúde
14.
Epilepsy Behav ; 136: 108916, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36179607

RESUMO

OBJECTIVE: This prospective study aimed at comparing quality of life (QoL) and psycho-socio-clinical profiles between patients with epilepsy, psychogenic nonepileptic seizures (PNES), and syncope. We also intended to identify predictors of QoL in these three seizure disorders. METHODS: A total of 245 inpatients (epilepsy n = 182, PNES n = 50, syncope n = 13) from a tertiary epilepsy clinic were included. Information on QoL as well as on psychological, sociodemographic, and clinical profiles was retrieved using questionnaires and medical records. Group comparisons on QoL and psycho-socio-clinical profiles were performed via analyses of variance, chi-square tests, and related post hoc tests. Predictors of QoL in epilepsy and PNES were determined using general linear modeling, which was not possible for syncope due to a small sample size. RESULTS: Patients with epilepsy, PNES, and syncope reported levels of QoL impairment that did not differ significantly between groups (p = 0.266). However, there were significant group differences regarding sex distribution (p < 0.001), seizure disorder duration (p = 0.004), seizure frequency (p = 0.019), current treatment with antiseizure medications (ASM) (p < 0.001), number of current ASM (p < 0.001), and adverse ASM events (p = 0.019). More depressive symptoms (p = 0.001), more adverse ASM events (p = 0.036), and unemployment (p = 0.046) (in this order) independently predicted a diminished QoL in epilepsy. For PNES, more depressive symptoms were the only independent predictor of lower QoL (p = 0.029). CONCLUSIONS: Patients with epilepsy, PNES, and syncope experience similarly diminished QoL and show a general psycho-socio-clinical burden with a specific pattern for each seizure disorder diagnosis. Although clinical aspects play an undisputed role for QoL in epilepsy, the psychosocial aspects and consequences are equally, or for PNES probably even more, meaningful. A comprehensive approach to research and treatment of seizure disorders seems mandatory to increase QoL for these patients. More research on QoL in syncope is needed.


Assuntos
Epilepsia , Qualidade de Vida , Humanos , Qualidade de Vida/psicologia , Estudos Transversais , Estudos Prospectivos , Epilepsia/psicologia , Síncope , Sistema de Registros , Convulsões , Eletroencefalografia
15.
Neurol Sci ; 43(12): 6889-6899, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36063254

RESUMO

OBJECTIVE: We constructed epilepsy multimorbidity networks to study associations with chronic conditions, and co-prescriptions and drug-disease networks to assess potential interactions. We conducted a population-based study in Catalonia, Spain, with electronic files of 3,135,948 adult patients with multimorbidity, 32,625 of them with epilepsy (active diagnosis any time during 2006-2017). We constructed epilepsy comorbidity networks using logistic regression models from odds ratio estimates adjusted by age, sex, and comorbidities with R software and generated trajectories to study the progression of epilepsy. We constructed drug-disease and co-prescription networks using mixed models with repeated measures adjusting by age, sex, and period with chronic prescription invoiced data. Comorbidity more frequently preceding epilepsy included cerebrovascular accident (OR: 3.59), congenital anomalies (2.18), and multiple sclerosis (1.33); and following epilepsy: dementia (1.91), personality disorder (1.59), alcohol abuse (1.22), and Parkinson (1.21). Mental retardation (13.08), neurological cancer (8.49), benign neoplasm (4.69), infections (3.14), and psychosis (1.58) might precede or not epilepsy. A common progression was to schizophrenia, dementia, and other neurological diseases (mainly cerebral palsy and other degenerative diseases of nervous system). Co-prescription associations with major-moderate potential interactions were 54% for carbamazepine, 61% phenytoin, 53% phenobarbital, and 32% valproate. Major potential interactions were with antipsychotic, anxiolytic, opioid, cardiovascular, and other anti-seizure medications (ASMs). The most frequent comorbidities of epilepsy were congenital, cerebrovascular, and neurological and psychiatric conditions. High comorbidity and co-prescription with potential interactions can increase the complexity of care of patients with epilepsy.


Assuntos
Demência , Epilepsia , Humanos , Adulto , Multimorbidade , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Epilepsia/psicologia , Fenitoína/uso terapêutico , Comorbidade , Prescrições , Demência/tratamento farmacológico
16.
BMC Neurol ; 22(1): 310, 2022 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-35999500

RESUMO

BACKGROUND: Childhood epilepsy causes a tremendous burden for the child, the family, society as well as the healthcare system. Adherence to anti-seizure medications (ASMs) is a key to treatment success. Poor adherence has been considered as one of the main causes of unsuccessful treatment for epilepsy and presents a potential ongoing challenge for achieving a key therapeutic goal of seizure control. METHODS: A facility-based cross-sectional study design was conducted among children with epilepsy attending the Pediatrics neurology follow up clinic of Jimma Medical Center from June- 21 to September- 20, 2021. Data were collected by using a semi-structured pre-tested questionnaire. Epidata version 3.1 and SPSS version 26.0 were used for data entry and analysis respectively. Descriptive statistics and binary logistic regression analysis were employed. Adjusted odds ratios were used to ascertain effect sizes for any association between the dependent and associated variables while significance level at p-value of < 0.05 was determined using 95% confidence intervals. RESULT: A total of 170 children with epilepsy were included in this study. About 54.7% were male and 44.7% were in age range of 10-17 years. The overall adherence to anti-seizure medications was 54.1%. Those caregivers who were married [AOR = 7.46 (95% CI = 1.46, 38.20)], those children with controlled seizure status [AOR = 3.64 (95% CI = 1.51, 8.78)], those who got appropriate health care [AOR = 7.08(95% CI = 2.91, 17.24)], those caregivers who had good knowledge [AOR = 5.20(95% CI = 2.60,14.83)]; and positive attitude [AOR = 2.57 (95% CI = 1.06, 6.28)] towards epilepsy were significantly associated with adherence to anti-seizure medications. CONCLUSIONS: More than half of the children/adolescents having epilepsy were adherent to their anti-seizure medication(s). Children's adherence to anti- seizure medications was influenced by current marital status of the parents/caregivers, controlled seizure status, getting appropriate healthcare in the hospital, caregiver's knowledge; and attitude towards epilepsy. More efforts are required to scale up the provision of client-centered service (provision of appropriate health care delivery, focus on quality of treatment and providing health education/counseling to improve caregivers' knowledge and attitude towards epilepsy) to improve children's adherence status to their medication(s) and seizure control status.


Assuntos
Epilepsia , Adesão à Medicação , Adolescente , Criança , Estudos Transversais , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Epilepsia/psicologia , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Inquéritos e Questionários , Centros de Atenção Terciária
17.
Eur J Paediatr Neurol ; 40: 61-68, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36031701

RESUMO

BACKGROUND: There is limited data on the views of young people with epilepsy, their parents and school staff regarding the impact of epilepsy on learning and behaviour in school. The purpose of the study was to gain an understanding of the impact of epilepsy on learning and behaviour and needed supports according to children with epilepsy, their parents and supporting school staff. METHODS: School-aged children (n = 20) with 'active epilepsy' (taking anti-seizure Medications (ASMs) for epilepsy), their parents (n = 68) and school staff (n = 56) were interviewed or completed surveys. The quantitative data was analysed using descriptive statistics and responses were compared for children attending mainstream and special schools using chi-square analyses. The answers to open questions were answered using thematic analyses. RESULTS: The majority (53%) of children with epilepsy felt that epilepsy affected their learning including aspects such as memory, attention and concentration but also physical and emotional wellbeing including increased tiredness and lowered self-confidence. In addition, children brought up possible negative aspects of taking ASMs including increased irritability and emotional reactivity. The children also mentioned that epilepsy in school was associated with stigma and restrictions. The majority (85%) of parents agreed that epilepsy affects the child's learning/behaviour while more staff agreed that epilepsy affects learning (61%) than behaviour (45%). Most parents agreed that that their child's school provided the appropriate resources to support their child's learning (79%) and 72% agreed that they were satisfied overall with the support their child received at school. However, parents of children attending special schools were more likely to agree that the child's school provided appropriate resources to support their child's learning (p = 0.034) and be satisfied with the support their child received in school (p = 0.02), than parents of children attending mainstream schools. With respect to current or desired supports, analysis of the children's responses indicated that they want access to supportive environments outside the classroom, accommodations in tests/exams and increased support from trusted adults. Parent responses included approaches that promote child wellbeing, environmental accommodations, a high ratio of adult support and a consideration of the child's communication needs. Staff views regarding optimal strategies included a high level of adult support for the child, environmental accommodations, use of multimodal learning, adapting communication and approaches that promote psychological wellbeing. CONCLUSIONS: The majority of children perceived that epilepsy affected their learning and behaviour in school including leading to specific learning difficulties, but also negative impacts on emotional and physical wellbeing. Levels of parental satisfaction with supports were significantly higher in special schools compared with mainstream schools. Children, parents and staff highlighted a number of supports which they felt can support the child with epilepsy's learning but also emotional wellbeing.


Assuntos
Epilepsia , Pais , Adolescente , Adulto , Criança , Epilepsia/psicologia , Humanos , Pais/psicologia , Instituições Acadêmicas , Autoimagem , Inquéritos e Questionários
18.
J Child Neurol ; 37(10-11): 840-850, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35921196

RESUMO

This study investigated the experiences of 25 caregivers of children with early-onset, treatment-resistant epilepsy who pursued whole exome sequencing to determine the impact of the test results on their child's treatment. Caregivers who consented to be recontacted were recruited from a previous study investigating the diagnostic yield of whole exome sequencing. A semistructured interview addressed questions based on one of 2 study phases. The first phase discussed the decision-making process for genetic testing (15 interviews), which revealed 4 major themes: (1) prognosis, (2) engagement, (3) concerns, and (4) autonomy. The second phase discussed the impact of genetic testing on treatment (10 interviews), which revealed 3 major themes: (1) testing features, (2) emotional impact, and (3) treatment outcomes. Overall, parents pursued genetic testing to obtain a clear prognosis, inform treatment decisions, engage with other families, and exercise autonomy. Caregivers felt that early testing is warranted to inform their child's diagnostic odyssey.


Assuntos
Epilepsia , Pais , Cuidadores , Criança , Epilepsia/diagnóstico , Epilepsia/genética , Epilepsia/psicologia , Testes Genéticos/métodos , Humanos , Pais/psicologia , Sequenciamento Completo do Exoma
19.
Epilepsy Behav ; 135: 108877, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35985165

RESUMO

BACKGROUND: Levetiracetam, a widely used anticonvulsant drug in children and adolescents, has been associated with irritability, psychosocial symptoms, and low quality of life, which are also influenced by other epilepsy variables. PURPOSE: The objective of this study was to investigate the level of treatment-related irritability in adolescents receiving levetiracetam, and to evaluate the relationship between irritability levels and psychosocial symptoms, and quality of life. METHODS: A cross-sectional, case-control study was conducted. Consecutive adolescent patients with epilepsy aged 11-17 years with partial or generalized seizures, treated with either levetiracetam or valproic acid for at least 6 months, and healthy controls were recruited. The Affective Reactivity Index parent report and self-report, Strengths and Difficulties Questionnaire, and Pediatric Quality of Life Inventory-Psychosocial subscale were utilized to assess irritability, psychosocial symptoms, and functioning. RESULTS: A total of 120 participants were analyzed; 33 patients in the LEV group, 45 patients in the VPA group, and 42 healthy controls. Both self and parent report irritability levels of the LEV group were found to be significantly higher than those of healthy controls. The irritability levels of the LEV and VPA groups were not statistically different, but still the LEV group had higher irritability levels on both scales. In the LEV group, irritability was positively correlated with behavioral, emotional, and attention/hyperactivity problems, and also negatively correlated with psychosocial quality of life. CONCLUSION: Adolescents with epilepsy using LEV have a high level of irritability and this is associated with some psychosocial symptoms and poor quality of life.


Assuntos
Epilepsia , Piracetam , Adolescente , Anticonvulsivantes/efeitos adversos , Estudos de Casos e Controles , Criança , Estudos Transversais , Epilepsia/tratamento farmacológico , Epilepsia/psicologia , Humanos , Levetiracetam/uso terapêutico , Piracetam/efeitos adversos , Qualidade de Vida , Ácido Valproico/uso terapêutico
20.
Epilepsy Behav ; 135: 108870, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35988325

RESUMO

The view that epilepsy is caused by demonic possession prevailed throughout the Middle Ages and re-emerges in rare cases of misguided exorcisms even in modern Western societies. This review reflects on the biblical sources of the demonic understanding of seizures and the subsequent marginalization of people with epilepsy. While the development of science led to a decline in beliefs of supernatural causes of seizures, the link between Christianity and epileptology is sustained through recurrent considerations of epileptic phenomena among religious figures. The influence of epilepsy on the legacy of historical persons of Christianity should be regarded with caution because of limited clinical evidence in historical documents. However, it should be acknowledged that religious experiences, as well as general religiosity, can be important in modern-day epilepsy care as they are shown to have psychological, societal, and even clinical implications. Further studies should expand our knowledge on the contemporary importance of the Christian tradition for people with epilepsy.


Assuntos
Epilepsia , Santos , Cristianismo/psicologia , Epilepsia/psicologia , Humanos , Conhecimento , Pessoa de Meia-Idade , Convulsões
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