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1.
Epilepsia ; 62(1): 41-50, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33258109

RESUMO

OBJECTIVE: Our epilepsy population recently experienced the acute effects of the COVID-19 pandemic in New York City. Herein, we aimed to determine patient-perceived seizure control during the surge, specific variables associated with worsened seizures, the prevalence of specific barriers to care, and patient-perceived efficacy of epilepsy care delivered via telephone and live video visits during the pandemic. METHODS: We performed a cross-sectional questionnaire study of adult epilepsy patients who had a scheduled appointment at a single urban Comprehensive Epilepsy Center (Montefiore Medical Center) between March 1, 2020 and May 31, 2020 during the peak of the COVID-19 pandemic in the Bronx. Subjects able to answer the questionnaire themselves in English or Spanish were eligible to complete a one-time survey via telephone or secure online platform (REDCap). RESULTS: Of 1212 subjects screened, 675 were eligible, and 177 adequately completed the questionnaire. During the COVID-19 pandemic, 75.1% of patients reported no change in seizure control, whereas 17.5% reported that their seizure control had worsened, and 7.3% reported improvement. Subjects who reported worsened seizure control had more frequent seizures at baseline, were more likely to identify stress and headaches/migraines as their typical seizure precipitants, and were significantly more likely to report increased stress related to the pandemic. Subjects with confirmed or suspected COVID-19 did not report worsened seizure control. Nearly 17% of subjects reported poorer epilepsy care, and 9.6% had difficulty obtaining their antiseizure medications; these subjects were significantly more likely to report worse seizure control. SIGNIFICANCE: Of the nearly 20% of subjects who reported worsened seizure control during the COVID-19 pandemic, stress and barriers to care appear to have posed the greatest challenge. This unprecedented pandemic exacerbated existing and created new barriers to epilepsy care, which must be addressed.


Assuntos
Atitude Frente a Saúde , /psicologia , Epilepsia/psicologia , Epilepsia/terapia , Acesso aos Serviços de Saúde , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , População Urbana , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Estudos Transversais , Epilepsia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Satisfação do Paciente , Consulta Remota , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
2.
Seizure ; 83: 203-207, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33227658

RESUMO

BACKGROUND: Few studies have examined factors associated with health-related quality of life (HRQoL) in youth with psychogenic non-epileptic seizures (PNES). In adults, internalizing symptoms such as depression have been shown to be more closely associated with HRQoL than seizure frequency, however, this has not been studied in samples of youth. Investigations into these areas are needed in order to enhance our understanding of the impact of this condition on children and adolescents and inform future clinical intervention. METHODS: The current study includes 37 youth and one of their parents who attended a clinic visit for treatment of PNES. Children and parents completed measures of psychological functioning, and medical data were extracted from patient charts. RESULTS: Parent-reported anxiety (B=-0.45, p = 0.05) and depression (B=-0.60, p = 0.01) were related to parent-report of HRQoL; self-report of depression was related to self-reported HRQoL (B=-0.90, p < 0.001). Seizure frequency, somatic complaints, and social problems were not related to HRQoL in this sample. CONCLUSIONS: Internalizing symptoms, not seizure frequency, are associated with poorer overall functioning in youth with PNES. Interventions focused on improving anxiety and depression in addition to seizure cessation may contribute to improved HRQoL in youth with PNES more so than those focused on seizure cessation alone.


Assuntos
Epilepsia/psicologia , Qualidade de Vida/psicologia , Convulsões/psicologia , Transtornos Somatoformes/psicologia , Adolescente , Adulto , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Criança , Depressão/psicologia , Epilepsia/diagnóstico , Feminino , Humanos , Masculino , Convulsões/diagnóstico , Transtornos Somatoformes/diagnóstico
3.
Ann Afr Med ; 19(4): 237-245, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33243946

RESUMO

Background: Epilepsy is a common presentation at clinics in Psychiatric Hospitals, Teaching Hospitals, and general practice. In developing countries and Africa especially, awareness, attitude, and understanding are generally poor. People still believe in spirits as the cause of epilepsy. Objectives: The objectives were to assess the awareness; attitude and knowledge of Hospital workers in general practice concerning epilepsy. Methodology: The respondents were workers of all cadres who were working at a State Specialist Hospital and the study used a survey method proposed by Caveness and Gallup, with modifications and adaptations on the self-administered questionnaire. Results: One hundred and forty-four staffs of State Specialist Hospital completed the questionnaire containing items addressing demographics, awareness, attitude, and knowledge. Of these respondents, 89 were males and 55 were females. The mean age was 34.34 years. 96.5% heard of the disease, 77.8% knew someone with the disease, 64.6% will not object to their children playing with someone with epilepsy and 37.5% will not allow a relative to marry someone with epilepsy. Fifty-five percent (55%) of the respondents said; they will not employ such patients, and that patients with epilepsy should not be employed with others. Knowledge towards epilepsy was good, where 71.5% felt it was caused by a brain disorder. Conclusion: We found out that awareness and knowledge of epilepsy among Hospital staff were generally good. However, the attitude of healthcare workers had reservations towards patients with epilepsy (PWE) either working for them or working with other people. This attitude arose from deeply ingrained cultural misconceptions acquired over time. Thus, there is a need for consistent hospital staff education, aimed at allaying fears, mistrust as well as to lessen the stigma towards epileptics.


Assuntos
Epilepsia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Adolescente , Adulto , Idoso , Conscientização , Epilepsia/epidemiologia , Epilepsia/etiologia , Feminino , Inquéritos Epidemiológicos , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Inquéritos e Questionários , Adulto Jovem
4.
Epilepsy Behav ; 113: 107527, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33242768

RESUMO

The recent COVID-19 pandemic has disrupted care systems around the world. We assessed how the COVID-19 pandemic affected children with epilepsy in Italy, where lockdown measures were applied from March 8 to May 4, 2020. We compiled an Italian-language online survey on changes to healthcare and views on telehealth. Invitations were sent to 6631 contacts of all patients diagnosed with epilepsy within the last 5 years at the BambinoGesù Children's Hospital in Rome. Of the 3321 responses received, 55.6% of patients were seizure-free for at least 1 year before the COVID-19-related lockdown, 74.4% used anti-seizure medications (ASMs), and 59.7% had intellectual disability. Only 10 patients (0.4%) became infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Seizure frequency remained stable for most patients during the lockdown period (increased in 13.2%; decreased in 20.3%), and seizure duration, use of rescue medications, and adherence to treatment were unchanged. Comorbidities were more affected (behavioral problems worsened in 35.8%; sleep disorder worsened in 17.0%). Visits were canceled/postponed for 41.0%, but 25.1% had remote consultation during the lockdown period (93.9% were satisfied). Most responders (67.2%) considered continued remote consultations advantageous. Our responses support that patients/caregivers are willing to embrace telemedicine for some scenarios.


Assuntos
/psicologia , Cuidadores/psicologia , Cuidadores/tendências , Epilepsia/psicologia , Telemedicina/tendências , Adolescente , /terapia , Criança , Pré-Escolar , Epilepsia/epidemiologia , Epilepsia/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pandemias , Inquéritos e Questionários
5.
Epilepsy Behav ; 113: 107599, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33238236

RESUMO

OBJECTIVE: The emergence of SARS-CoV-2 (COVID-19) as a novel coronavirus resulted in a global pandemic that necessitated the implementation of social distancing measures. These public health measures may have affected the provision of care for patients with epilepsy. Social isolation may have also adversely affected well-being and quality of life due to informal and formal support networks becoming less accessible. The purpose of this qualitative study was to examine the lived experiences of patients with epilepsy and to see how their quality of life and healthcare has been affected by the COVID-19 pandemic. METHODS: From April 27 to May 15, 2020 we performed remote interviews with 18 participants who had virtual appointments with their healthcare providers and were enrolled in the Calgary Comprehensive Epilepsy Program registry. Interviews were recorded and transcribed, after which transcripts were analyzed and coded into relevant themes using NVivo 12. RESULTS: Three broad themes emerged throughout the interviews:1) impact of pandemic on informal and formal support systems; 2) impact of pandemic on healthcare provision; and 3) concerns about the impact of the pandemic on personal situations and society in the future. Participants reported anxiety and stress about decreased social engagement and activity cessations. Although face-to-face appointments were preferred, virtual care was well-received. Common concerns about the future included securing employment and burnout from balancing family responsibilities. Some patients also feared they would be stigmatized as society adapted to the situation. SIGNIFICANCE: This study highlights the need for additional research in anticipation of the implementation of remote medicine in the management and treatment of epilepsy. It also highlights the tenacity of those living with epilepsy during difficult periods despite social and familial pressures. Raising awareness during this time about the lives and experiences of epilepsy patients can help challenge misconceptions and stigma in the workplace and wider society.


Assuntos
/epidemiologia , Epilepsia/epidemiologia , Epilepsia/psicologia , Isolamento Social/psicologia , Telemedicina/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Alberta/epidemiologia , Epilepsia/terapia , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Telemedicina/métodos , Adulto Jovem
6.
Seizure ; 83: 187-192, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33181426

RESUMO

PURPOSE: To evaluate psychosocial long-term outcome in patients diagnosed with psychogenic nonepileptic seizures (PNES) and to predict outcome of PNES, economic status, and quality of life (QoL) at follow-up. METHODS: Patients diagnosed with PNES in the video-EEG-monitoring unit at our Epilepsy center between 2002-2016 were contacted by phone 1-16 years after communicating the diagnosis. Patients underwent a structured interview asking for current PNES status, psychosocial situation (economic status, marital status, setting of living, driving), depression, and QoL. RESULTS: Of 70 PNES patients without comorbid epilepsy (age: 41.1 ± 13.5 years; 74 % female, follow-up: 5.2 ± 4.2 years), 23 patients (33 %) reported to be free of PNES during the last 12 months. Patients with cessation of PNES were younger at PNES onset (p < .01) and diagnosis (p < .01) and had a higher education (p < .05). At follow-up, the proportion of economically active patients only increased in individuals with cessation of PNES (p < .001) while an increased number of patients with persisting PNES relied on governmental support (p < .001). Cessation of PNES was associated with better mood (p < .01) and QoL (p < .001). In multiple regression models, cessation of PNES was only predicted by younger age at onset, while good economic outcome was determined by younger age and good economic status at diagnosis and cessation of PNES at follow-up. Good QoL at follow-up was predicted by low depressive symptoms, freedom of PNES, and economic activity at follow-up. CONCLUSION: Long-term outcome in patients with PNES remains to be poor and the majority of patients continue to have PNES. Cessation of PNES was associated with good economic outcome, mood, and QoL.


Assuntos
Epilepsia/psicologia , Qualidade de Vida/psicologia , Convulsões/psicologia , Transtornos Somatoformes/psicologia , Adulto , Afeto/fisiologia , Eletroencefalografia/métodos , Epilepsia/diagnóstico , Epilepsia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/diagnóstico , Convulsões/terapia , Fatores Socioeconômicos , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia
7.
Medicine (Baltimore) ; 99(44): e22978, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126370

RESUMO

This cross-sectional study aimed to assess the impact of epilepsy, myasthenia gravis (MG), and multiple sclerosis (MS) on pregnancy and family planning decision-making in a cohort of Saudi women. Women with epilepsy, MG, and MS were recruited consecutively at the time of their follow-up visits at a neurology clinic. Data were collected using 3 standardized questionnaires, and presented using descriptive statistics. A logistic regression was performed to determine variables associated with decisions regarding abstaining from pregnancy and encouraging other women to conceive. A total of 272 (83 epilepsy, 69 MG, and 120 MS) women with a mean age of 29.9 ±â€Š8.0 years participated. The proportion of women who abstained from or postponed pregnancy was 41.2% and 31.4%, respectively. The concerns mentioned most often were disease worsening during pregnancy, peripartum and postpartum, side effects of medications on the unborn child, and inability to care for the child. Older age was independently associated with the decision to abstain from pregnancy (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04 - 1.25). Higher knowledge levels were independently associated with encouraging other women to have children (OR 1.3, 95% CI 1.11-1.53). Over 50% of women reported that they were not counseled on issues related to pregnancy and childbirth. In conclusion, we identified a major influence of epilepsy, MG, and MS on pregnancy and family planning. Comprehensive counseling programs are needed to help women with these neurological diseases make informed family-planning decisions.


Assuntos
Epilepsia/psicologia , Serviços de Planejamento Familiar , Esclerose Múltipla/psicologia , Miastenia Gravis/psicologia , Adulto , Estudos Transversais , Escolaridade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Logísticos , Inquéritos e Questionários
8.
Seizure ; 83: 124-131, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33120324

RESUMO

BACKGROUND: Caregiving to patients with epilepsy (PWE) is often very stressful for family caregivers and puts a heavy caregiver burden (CB) on them. The aim of this study was to evaluate the effects of Fordyce's fourteen Fundamentals for Happiness Program on happiness and CB among the family caregivers of PWE. METHODS: This randomized controlled trial was conducted on seventy family caregivers of PWE. Participants were purposively recruited from the Comprehensive Health Center in Shahrekord, Iran, and randomly allocated to either an intervention or a control group. Participants in the control group received conventional health-related educations in four one-hour group sessions, while participants in the intervention group received the Fordyce's fourteen Fundamentals for Happiness Program in eight one-hour group sessions. Happiness and CB in both groups were assessed at three time points, namely before, immediately after, and two months after the intervention. Data were analyzed using the SPSS program (v. 18.0). FINDINGS: There were no significant differences between the control and the intervention groups regarding participants' demographic characteristics and their pretest mean scores of happiness and CB (P > 0.05). The mean scores of happiness and CB in the control group did not significantly change (P > 0.05), while the mean score of happiness significantly increased and the mean score of CB significantly decreased in the intervention group across the three measurement time points (P < 0.05). Consequently, the mean score of happiness in the intervention group was significantly greater than the control group and the mean score of CB in the intervention group was significantly less than the control group at both posttests (P < 0.01). CONCLUSION: The Fordyce's fourteen Fundamentals for Happiness Program is effective in significantly increasing happiness and reducing CB among the family caregivers of PWE. Healthcare providers and policy makers can use this program to reduce problems among these family caregivers.


Assuntos
/psicologia , Cuidadores/psicologia , Epilepsia/psicologia , Felicidade , Estresse Psicológico/psicologia , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
9.
Seizure ; 83: 83-88, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33120326

RESUMO

PURPOSE: Surgical procedures are increasingly used as a treatment option for paediatric patients with refractory epilepsy as seizure relief is often assumed to be associated with positive psychosocial and quality of life outcomes. This study aimed to explore children's and parents' experiences of epilepsy surgery and associated psychosocial outcomes. METHODS: Semi-structured interviews were conducted with parents and their children aged between 7 and 17 years old, who had undergone epilepsy surgery within the previous six months to three years. Analysis of interview data was interpretive and iterative, using the constant comparison approach, to develop a rich understanding of family experiences throughout the surgery journey. RESULTS: Interviews were conducted with 16 participants including seven children (aged 8-15 years) and their nine parents. Epilepsy had significant impact on quality of life for children and parents. Concerns about long term wellbeing, risks to safety and hope for a 'normal' life contributed to the decision to pursue surgery. All participants described improvements in seizure control, alongside improved psychological wellbeing, quality of life, social relationships and family functioning. However, children and their parents experienced difficulties adjusting to a new post-surgical identity and 'missing' aspects of their pre-surgical life with epilepsy. CONCLUSIONS: Epilepsy surgery had a positive impact on participants' lives, but families described difficulties in adjusting to postsurgical changes and leading a 'normal' life. Our findings suggest that families would benefit from additional information and clinical support leading up to epilepsy surgery to help them prepare for and adjust to a life without epilepsy.


Assuntos
Epilepsia Resistente a Medicamentos/psicologia , Epilepsia/psicologia , Pais/psicologia , Qualidade de Vida/psicologia , Adolescente , Criança , Família/psicologia , Feminino , Humanos , Masculino , Pesquisa Qualitativa
10.
Seizure ; 83: 216-222, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33127274

RESUMO

This is the first of two narrative reviews on cognitive disorders in epilepsy (companion publication : Cognitive disorders in epilepsy II: Clinical targets, indications and selection of test instruments). Its focus is on clinical experience, real-world evidence, and clinical recommendations. Cognitive disorders are a common comorbidity in children and adults with epilepsy. These cognitive disturbances may preceed the onset of seizures and are multifactorial including contributions by pre-existing brain damage, seizures, interictal epileptic discharges, and treatments including medications and surgery. Comorbid cognitive impairments can have a negative impact on the quality of life in people with epilepsy. They are under-identified and frequently not treated. Comorbid psychiatric disorders, such as ADHD can also contribute to a worse cognitive performance and can benefit from pharmacotherapy with CNS stimulants. Likewise, mood disorders cause a subjective perception of poor memory and attention, which can be reversed with antidepressants of the SSRI family. This narrative review discusses these issues from a real-world clinical perspective in children and adults with newly diagnosed and chronic epilepsy. The need for further research to understand and treat these disorders is noted.


Assuntos
Anticonvulsivantes/uso terapêutico , Transtornos Cognitivos/etiologia , Epilepsia/tratamento farmacológico , Convulsões/tratamento farmacológico , Cognição/efeitos dos fármacos , Cognição/fisiologia , Transtornos Cognitivos/psicologia , Epilepsia/psicologia , Humanos , Qualidade de Vida/psicologia , Convulsões/psicologia
11.
Cochrane Database Syst Rev ; 10: CD008312, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33089492

RESUMO

BACKGROUND: Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials (RCTs) and quasi-RCTs to assist people with adherence to antiepileptic medication. This is an update of a Cochrane review first published in 2011, and last updated in 2017. OBJECTIVES: To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy. SEARCH METHODS: For the latest update, we searched the following databases on 18 February 2020: Cochrane Register of Studies (CRS Web), MEDLINE, CINAHL Plus and PsycINFO. CRS Web includes RCTs or quasi-RCTs from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), CENTRAL, and the Specialized Registers of Cochrane Review Groups including Epilepsy. We also searched the reference lists of relevant articles. SELECTION CRITERIA: RCTs and quasi-RCTs of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy (as defined in individual studies), of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting. DATA COLLECTION AND ANALYSIS: All review authors independently assessed lists of potentially relevant citations and abstracts. At least two review authors independently extracted data and performed a quality assessment of each study according to the Cochrane tool for assessing risk of bias. We graded the level of evidence for each outcome according to GRADE. The studies differed widely according to the type of intervention and measures of adherence; therefore combining data was not appropriate. MAIN RESULTS: We included 20 studies reporting data on 2832 participants. Thirteen studies targeted adults with epilepsy, one study included participants of all ages, one study included participants older than two years, one recruited pediatric patients aged between 1 month to 15 years, one study targeted caregivers of children with epilepsy, one targeted adolescents and caregivers, and two studies targeted families of children with epilepsy. We identified three ongoing studies. Follow-up time was generally short in most studies, ranging from 1 to 12 months. The studies examined three main types of interventions: educational interventions, behavioural interventions and mixed interventions. All but three studies compared treatment with usual care or 'no intervention'. Due to heterogeneity between studies in terms of interventions, methods used to measure adherence and the way the studies were reported, we did not pool the results and these findings were inappropriate to be included in a meta-analysis. Education and counselling of participants with epilepsy had mixed success (moderate-certainty evidence). Behavioural interventions such as the use of intensive reminders provided more favourable effects on adherence (moderate-certainty evidence). The effect on adherence to antiepileptic drugs described by studies of mixed interventions showed improved adherence in the intervention groups compared to the control groups (high-certainty evidence). Eleven studies described seizure frequency or seizure severity or both, with four of them, reporting improved adherence and decreased seizure frequency in the intervention groups (moderate-certainty evidence). Findings related to self-efficacy and quality of life were mixed, with no clear pattern across types of intervention. AUTHORS' CONCLUSIONS: Behavioural interventions such as intensive reminders and the use of mixed interventions demonstrate some positive results, however, we need more reliable evidence on their efficacy, derived from carefully-designed RCTs before we can draw a firm conclusion. None of the newly included studies have provided additional information that would lead to significant changes in our conclusions.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Adesão à Medicação/psicologia , Adulto , Viés , Criança , Análise Custo-Benefício , Epilepsia/psicologia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoeficácia
12.
Nat Commun ; 11(1): 5240, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067457

RESUMO

Spoken language, both perception and production, is thought to be facilitated by an ensemble of predictive mechanisms. We obtain intracranial recordings in 37 patients using depth probes implanted along the anteroposterior extent of the supratemporal plane during rhythm listening, speech perception, and speech production. These reveal two predictive mechanisms in early auditory cortex with distinct anatomical and functional characteristics. The first, localized to bilateral Heschl's gyri and indexed by low-frequency phase, predicts the timing of acoustic events. The second, localized to planum temporale only in language-dominant cortex and indexed by high-gamma power, shows a transient response to acoustic stimuli that is uniquely suppressed during speech production. Chronometric stimulation of Heschl's gyrus selectively disrupts speech perception, while stimulation of planum temporale selectively disrupts speech production. This work illuminates the fundamental acoustic infrastructure-both architecture and function-for spoken language, grounding cognitive models of speech perception and production in human neurobiology.


Assuntos
Córtex Auditivo/fisiopatologia , Epilepsia/fisiopatologia , Estimulação Acústica , Adulto , Córtex Auditivo/diagnóstico por imagem , Mapeamento Encefálico , Epilepsia/diagnóstico por imagem , Epilepsia/psicologia , Feminino , Humanos , Idioma , Imagem por Ressonância Magnética , Masculino , Fala , Percepção da Fala , Adulto Jovem
13.
Epilepsy Behav ; 112: 107396, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32911299

RESUMO

BACKGROUND: The aim of this study was to have a better understanding of the influence of the coronavirus disease 2019 (COVID-19) pandemic in people with epilepsy (PWE) and to assess whether there have been changes in seizure control during the current COVID-19 outbreak, exploring the possible causes thereof. METHODS: This is an observational, retrospective study based on prospective data collection of 100 successive patients who attended an epilepsy outpatient clinic either face-to-face or telephonically during the months of the COVID-19 outbreak and national state of emergency. RESULTS: One hundred patients were included, 52% women, mean age 42.4 years. During the COVID-19 period, 27% of the patients presented an increase of >50% of seizure frequency. An increase of stress/anxiety (odds ratios (OR): 5.78; p = 0.008) and a prior higher seizure frequency (OR: 12.4; p = 0.001) were associated with worsening of seizures. Other risk factors were exacerbation of depression, sleep deprivation, less physical activity, and history of epilepsy surgery. Three patients had status epilepticus (SE) and one a cluster of seizures. Likewise, 9% of patients improved their seizure control. Reduction in stress/anxiety (OR: 0.05; p = 0.03) and recent adjustment of antiepileptics (OR: 0.07; p = 0.01) acted as protecting factors. CONCLUSIONS: A high proportion of PWE suffered a significant worsening of their seizure control during the months of the COVID-19 pandemic. Emotional distress due to home confinement was the main factor for the change in seizure control. Promoting physical activity and adequate sleep may minimize the potential impact of the pandemic in PWE. Ensuring correct follow-up can prevent decompensation in those PWE at high risk.


Assuntos
Anticonvulsivantes/uso terapêutico , Ansiedade/fisiopatologia , Infecções por Coronavirus , Epilepsia/fisiopatologia , Pandemias , Pneumonia Viral , Estresse Psicológico/fisiopatologia , Adolescente , Adulto , Ansiedade/psicologia , Betacoronavirus , Depressão/fisiopatologia , Depressão/psicologia , Progressão da Doença , Epilepsia/tratamento farmacológico , Epilepsia/psicologia , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Convulsões/fisiopatologia , Privação do Sono/fisiopatologia , Espanha , Estado Epiléptico/fisiopatologia , Estresse Psicológico/psicologia
14.
Epilepsy Behav ; 112: 107442, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32949966

RESUMO

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has affected people globally, and people with chronic diseases are suffering more in maintaining their mental and physical health. METHOD: This cross-sectional, case-control study assessed the anxiety level in people with epilepsy compared with the general population. RESULTS: The results showed that 13.5% of patients had experienced a severe level of anxiety, but the mean anxiety level between groups did not show significant difference. CONCLUSION: Although still many aspects of the pandemic on people with epilepsy are yet to be determined, active investigation of psychological sequels of the pandemic is demanded.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus/epidemiologia , Epilepsia/psicologia , Pneumonia Viral/epidemiologia , Adulto , Ansiedade/psicologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Betacoronavirus , Estudos de Casos e Controles , Coronavirus , Estudos Transversais , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
15.
Sci Rep ; 10(1): 13667, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32788606

RESUMO

Perampanel (PER) is a new-generation antiepileptic drug that has an occasional but significant shortcoming, psychiatric adverse effects (PAEs). Recently, antiepileptic drug-related adverse reactions, such as skin rash and even PAEs, have been discovered to be correlated with certain human leukocyte antigen (HLA) types. Thus, we aimed to analyze specific HLA alleles as risk factors for PER-PAEs. We prospectively enrolled 17 patients with epilepsy who were prescribed PER between May 2016 and Jul 2018 at Seoul National University Hospital and developed PAEs while taking PER. Their HLA types were analyzed compared to those of 19 patients in the PAE-tolerant group and the general Korean population. In silico docking was performed with two different computational programs, AutoDock Vina and SwissDock, to theoretically evaluate the binding affinity of PER in the grooves of the specific HLA alleles. The HLA-DQB1*06:01, DRB1*08:03, and B*54:01 alleles were significantly associated with the patients who developed PER-PAEs compared with the general Korean population (odds ratio [OR] 3.94, p = 0.008, OR 9.24, p = 0.037, and OR 3.25, p = 0.041, respectively). As a haplotype, the combination of the three alleles was significantly more frequent in the PER-PAE group than in both the PER-tolerant group and the general Korean population. DQB1*06:01 and B*54:01 also demonstrated higher docking scores with PER than other alleles. This is the first study to analyze the association of PER-PAEs with specific HLA genotypes. Our results suggest that an HLA-associated genetic predisposition and a possible immunological mechanism are involved in the occurrence of PER-PAEs.


Assuntos
Anticonvulsivantes/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Epilepsia/tratamento farmacológico , Cadeias beta de HLA-DQ/metabolismo , Transtornos Mentais/epidemiologia , Piridonas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/metabolismo , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Epilepsia/patologia , Epilepsia/psicologia , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Incidência , Masculino , Transtornos Mentais/etiologia , Transtornos Mentais/metabolismo , Transtornos Mentais/patologia , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Adulto Jovem
16.
Epilepsia ; 61(9): 1884-1893, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32761900

RESUMO

OBJECTIVE: Stress is a known trigger for seizures in patients with epilepsy (PWE). However, the association between stress and seizures has not been thoroughly investigated. In December 2019, an outbreak of coronavirus disease (COVID-19) occurred in Wuhan, Hubei province, China, causing tremendous collateral stress. This study was designed to evaluate the influence of the COVID-19 outbreak on seizures in PWE in the most severely affected area, Wuhan, and its surrounding cities. METHODS: In this single-center, cross-sectional study, PWE were surveyed via online questionnaires between February 23 and March 5, 2020. Collected data included demographic information, epilepsy-related characteristics (seizure type, frequency, antiepileptic drugs [AEDs], and medication management), direct and perceived threat of COVID-19, and changes in seizures during the outbreak. Psychological comorbidities were evaluated by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 items, and Insomnia Severity Index (ISI). Multivariate logistic regression was used to identify precipitants for seizure exacerbation. RESULTS: We received 362 completed questionnaires after excluding 12 duplicates (response rate = 63.51%). A total of 31 (8.56%) patients had increased seizures during the outbreak. Exposure history to COVID-19 (P = .001), uncontrolled seizure after AED therapy (P = .020), seizure frequency of two or more times per month before the outbreak (P = .005), change of AED regimen during the outbreak (AED reduction, withdrawal, replacement, skipping altogether; P = .002), and worry about the adverse effect of the outbreak on overall seizure-related issues (severity = moderate to critical; P = .038) were risk factors for increased seizures. SIGNIFICANCE: A minority of PWE experienced seizure exacerbation during the outbreak of COVID-19. Stress, uncontrolled seizures, and inappropriate change in AED regimen were associated with increased seizures. Based on these findings, stress might be an independent precipitant for triggering seizures in some PWE.


Assuntos
/psicologia , Epilepsia/psicologia , Convulsões/psicologia , Estresse Psicológico/psicologia , Exacerbação dos Sintomas , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
17.
Ann Afr Med ; 19(3): 164-169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820727

RESUMO

Background: Quality of life (QOL) is a vital outcome measure in people living with epilepsy. The aim of this study is to determine the sociodemographic and clinical factors that predict poor QOL in patients with epilepsy. Materials and Methods: This is a descriptive cross-sectional study that was carried out at the outpatient psychiatric clinic of Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria, for 6 months. Seventy-four patients with epilepsy who met the inclusion criteria were recruited to participate in the study. The mental health of these patients and their QOL were assessed using the Mini-International Neuropsychiatric Interview and the short form of the World Health Organization QOL instrument, respectively. Data were analyzed using epi-info version 6.04d, and logistic regression analysis was performed to determine factors that predict poor QOL. Results: Psychiatric disorder was found in 33 (44.6%) of the respondents. The presence of these psychiatric disorders was predictive of poor score on the overall QOL (odds ratio [OR] = 0.382; 95% confidence interval [CI] = 0.145-0.983; P = 0.0046), physical (OR = 0.269; 95% CI = 0.100-1.722; P = 0.009), and psychological health domain (OR = 0.269; 95% CI = 0.102-0.709; P = 0.008). Longer duration of epilepsy was predictive of a poor score on the health satisfaction item (OR = 0.202; 95% CI = 0.06-0.679; P = 0.010) while being single was predictive of poor score on the social relationship domain (OR = 0.177; 95% CI = 0.065-0.482; P = 0.001). Conclusion: The presence of psychiatric disorder, long duration of epilepsy, and being single were predictive of poor QOL. The importance of social relation, prompt seizure control, and efficient collaboration between psychiatrist and other medical professionals in the care of patients with epilepsy cannot be overemphasized.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Epilepsia/complicações , Epilepsia/psicologia , Qualidade de Vida/psicologia , Adulto , Anticonvulsivantes/uso terapêutico , Ansiedade/psicologia , Estudos Transversais , Depressão/psicologia , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Escalas de Graduação Psiquiátrica , Convulsões/epidemiologia , Convulsões/psicologia , Inquéritos e Questionários , Organização Mundial da Saúde
18.
Acta Neurol Scand ; 142(6): 545-554, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32799337

RESUMO

OBJECTIVES: Collateral damage may occur in epilepsy management during the coronavirus (COVID-19) pandemic. We aimed to establish the impact of this pandemic on epilepsy patients in terms of patient-reported seizure control and emerging symptoms. MATERIALS & METHODS: This is a cross-sectional study including consecutive patients assessed by telephone contact in an epilepsy clinic during the first month of confinement. Demographic and clinical characteristics were recorded, and a 19-item questionnaire was systematically completed. Data regarding the impact of confinement, economic effects of the pandemic, and subjective perception of telemedicine were recorded. Additional clinical data were obtained in patients with a COVID-19 diagnosis. RESULTS: Two hundred and fifty-five patients were recruited: mean age 48.2 ± 19.8 years, 121 (47.5%) women. An increase in seizure frequency was reported by 25 (9.8%) patients. Sixty-eight (26.7%) patients reported confinement-related anxiety, 22 (8.6%) depression, 31 (12.2%) both, and 72 (28.2%) insomnia. Seventy-three (28.6%) patients reported a reduction in economic income. Logistic regression analysis showed that tumor-related epilepsy etiology [OR = 7.36 (95% CI 2.17-24.96)], drug-resistant epilepsy [OR = 3.44 (95% CI 1.19-9.95)], insomnia [OR = 3.25 (95% CI 1.18-8.96)], fear of epilepsy [OR = 3.26 (95% CI 1.09-9.74)], and income reduction [OR = 3.65 (95% CI 1.21-10.95)] were associated with a higher risk of increased seizure frequency. Telemedicine was considered satisfactory by 214 (83.9%) patients. Five patients were diagnosed with COVID-19, with no changes in seizure frequency. CONCLUSIONS: The COVID-19 pandemic has effects in epilepsy patients. Patients with tumor-related, drug-resistant epilepsy, insomnia, and economic difficulties are at a higher risk of increased seizure frequency. Telemedicine represents a suitable tool in this setting.


Assuntos
Epilepsia , Exacerbação dos Sintomas , Adulto , Idoso , Estudos Transversais , Epilepsia/epidemiologia , Epilepsia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
19.
J Neurosci ; 40(31): 6068-6081, 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32601243

RESUMO

Epilepsy is often associated with emotional disturbances and the endocannabinoid (eCB) system tunes synaptic transmission in brain regions regulating emotional behavior. Thus, persistent alteration of eCB signaling after repeated seizures may contribute to the development of epilepsy-related emotional disorders. Here we report that repeatedly eliciting seizures (kindling) in the amygdala caused a long-term increase in anxiety and impaired fear memory retention, which was paralleled by an imbalance in GABA/glutamate presynaptic activity and alteration of synaptic plasticity in the basolateral amygdala (BLA), in male rats. Anandamide (AEA) content was downregulated after repeated seizures, and pharmacological enhancement of AEA signaling rescued seizure-induced anxiety by restoring the tonic control of the eCB signaling over glutamatergic transmission. Moreover, AEA signaling augmentation also rescued the seizure-induced alterations of fear memory by restoring the phasic control of eCB signaling over GABAergic activity and plasticity in the BLA. These results indicate that modulation of AEA signaling represents a potential and promising target for the treatment of comorbid emotional dysfunction associated with epilepsy.SIGNIFICANCE STATEMENT Epilepsy is a heterogeneous neurologic disorder commonly associated with comorbid emotional alterations. However, the management of epilepsy is usually restricted to the control of seizures. The endocannabinoid (eCB) system, particularly anandamide (AEA) signaling, controls neuronal excitability and seizure expression and regulates emotional behavior. We found that repeated seizures cause an allostatic maladaptation of AEA signaling in the amygdala that drives emotional alterations. Boosting AEA signaling through inhibition of its degradative enzyme, fatty acid amide hydrolase (FAAH), restored both synaptic and behavioral alterations. FAAH inhibitors dampen seizure activity in animal models and are used in clinical studies to treat the negative consequences associated with stress. Thereby, they are accessible and can be clinically evaluated to treat both seizures and comorbid conditions associated with epilepsy.


Assuntos
Sintomas Afetivos/fisiopatologia , Tonsila do Cerebelo/fisiopatologia , Ácidos Araquidônicos , Endocanabinoides , Epilepsia/fisiopatologia , Alcamidas Poli-Insaturadas , Transdução de Sinais , Sinapses , Sintomas Afetivos/etiologia , Sintomas Afetivos/psicologia , Amidoidrolases/fisiologia , Animais , Ansiedade/psicologia , Epilepsia/complicações , Epilepsia/psicologia , Medo/psicologia , Ácido Glutâmico/fisiologia , Excitação Neurológica , Masculino , Ratos , Ratos Long-Evans , Ácido gama-Aminobutírico/fisiologia
20.
Epilepsy Behav ; 112: 107323, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32712565

RESUMO

OBJECTIVES: The objective of the study was to assess if patients with epilepsy (PWE) experienced an increase in seizure frequency and self-reported stress during the COVID-19 pandemic. METHODS: This is a cross-sectional study conducted in Saudi Arabia in April 2020. An electronic self-administered questionnaire was distributed to PWE via their treating neurologist. The variables included were demographic and baseline clinical characteristics (age, gender, living situation, occupational status, type of epilepsy, duration of epilepsy, number of antiepileptic medications (AEDs), presence of known psychiatric illness, and use of psychiatric medications), their seizure control in the month prior to the pandemic, perceived stress during this period of time, sleep changes, compliance changes, and change in seizure control during the pandemic. RESULTS: A total of 156 patients completed the questionnaire, with 29.5% reporting an increase in seizure frequency. Additionally, 59.4% reported an increase in self-reported stress and 71.2% experienced a significant change in their sleep during this period. Higher baseline seizure frequency, more AEDs, noncompliance, increase in self-reported stress, and sleep changes are the significant factors associated with increase in seizure frequency during the pandemic. CONCLUSION: Identifying high-risk patients for seizure recurrence is important in order to provide them with adequate support to reduce such risk.


Assuntos
Anticonvulsivantes/uso terapêutico , Infecções por Coronavirus , Epilepsia/tratamento farmacológico , Pandemias , Pneumonia Viral , Transtornos do Sono-Vigília/epidemiologia , Estresse Psicológico/epidemiologia , Adulto , Betacoronavirus , Estudos Transversais , Emprego , Epilepsia/fisiopatologia , Epilepsia/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Psicotrópicos/uso terapêutico , Recidiva , Arábia Saudita/epidemiologia , Convulsões/tratamento farmacológico , Autorrelato , Sono , Transtornos do Sono-Vigília/psicologia , Estresse Psicológico/psicologia , Estudantes , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
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