Anxiety symptoms are the strongest predictor of quality of life in temporal lobe epilepsy

How do anxiety, depression, and stigma affect quality of life in people with epilepsy?

BACKGROUND

Anxiety, depression, and stigma can significantly affect the quality of life of people with epilepsy. This study was carried out to determine the relationship between these factors.

METHOD

The study was conducted with 325 people with epilepsy admitted to the neurology outpatient clinic of a training and research hospital in Istanbul, Türkiye. Data were collected using a General Information Form, the Depression in Neurological Disorders Scale-Epilepsy (NDDI-E), Generalized Anxiety Disorder-7 Scale (GAD-7), Epilepsy Self-Stigma Scale (ESSS), and Quality of Life in Epilepsy Scale (QOLIE-31). Data were analyzed using the Student's t-test, one-way ANOVA, Pearson correlation, and multiple linear regression test.

RESULTS

Of the included patients, 60.9 % were female, 61.5 % were married, and 84.3 % had generalized seizures. The mean anxiety score was 16.80 ± 6.13, and 13.5 % of patients had mild anxiety, 27.7 % had moderate anxiety, and 58.8 % had severe anxiety. The mean depression score was 14.07 ± 3.58, and 39.7 % of the patients were at risk for depression. The mean total score for stigma was 14.29 ± 5.67, and the mean total score of the quality of life scale was 47.54 ± 11.36. Quality of life decreased with increasing levels of depression (r = -0.418; p < 0.001), anxiety (r = -0.292; p < 0.001), and stigma (r = -0.224; p < 0.001). Depression, anxiety, stigma, and seizure frequency explained 25 % of the total variance in quality of life.

CONCLUSION

There was a negative correlation between anxiety, depression, stigma, and quality of life. These factors, as well as seizure frequency, were statistically significant predictors of quality of life in people with epilepsy.

Changes in anxiety after temporal lobe epilepsy surgery: A systematic review and meta-analysis

BACKGROUND

Temporal lobe epilepsy (TLE) is often accompanied by psychiatric manifestations, of which, anxiety is among the most common. While the effects of surgery or ablation on TLE and seizure outcomes, as well as neuropsychological outcomes, have been well studied, anxiety is an exception and has not been systematically examined. Our study aims to systematically review the changes in anxiety before and after TLE surgery.

METHODS

We systematically reviewed the existing literature on anxiety in the setting of TLE. Different electronic databases were queried for studies published until 3rd June 2024.

RESULTS

Eighteen studies with 1403 patients who had refractory TLE and underwent surgical treatment were included. Eight different anxiety scales were used in the included studies, with baseline anxiety rates of 5.3 % to 35.1 %. A significant reduction in anxiety was observed in studies using the Hamilton Anxiety Rating Scale, with a pooled change of -0.87 (95 % CI: -1.26, -0.48, P < 0.001) after surgery. Conversely, the State-Trait Anxiety Inventory (STAI) scores did not show significant changes, with pooled changes of -0.30 (95 % CI: -1.72, 1.12, P = 0.68) for the State (STAI-S) and 0.10 (95 % CI: -1.56, 1.77, P = 0.90) for Trait (STAI-T) anxiety types. Similarly, significant improvements in anxiety were observed on the Hospital Anxiety and Depression Scale, with a pooled change of -0.87 (95 % CI: -1.62, -0.12, P = 0.02) at the last follow-up.

CONCLUSION

Our findings indicate that TLE surgery leads to a significant reduction in anxiety levels, though evidence regarding subgroup differences, such as seizure-free versus non-seizure-free patients, remains limited due to the small number of studies. Additional research is necessary to clarify these findings and further assess the broader effects of surgery on anxiety.

The power spectrum and functional connectivity characteristics of resting-state EEG in patients with generalized anxiety disorder

Recent studies have suggested a relationship between abnormal neurophysiological functions and generalized anxiety disorder (GAD). However, studies on its electrophysiological characteristics, such as its power spectrum and functional connectivity are relatively few and scattered than those on other mental disorders (e.g., depression, ADHD, etc.). The present study aims to reveal the multidimensional electrophysiological characteristics of GAD via comparative analysis of electroencephalogram (EEG) data between GAD patients and healthy controls. Specifically, resting-state EEG, with a duration of 10 min, was recorded from 98 GAD patients and 92 healthy control participants. The electrophysiological characteristics, including the power spectrum, alpha asymmetry, and functional connectivity, were extracted and compared between the two groups. The results revealed significantly increased beta-band activity; decreased ipsilateral fronto-temporal and parieto-temporal functional connectivities in the lower frequency bands (theta-beta band); as well as decreased frontal‒parietal and frontal‒occipital connectivities in the higher frequency bands (beta‒gamma band) in GAD patients. Additionally, alpha asymmetry analysis revealed a significantly greater rightward temporal alpha asymmetry in GAD patients. These findings suggest the existence of significant EEG characteristics in patients with GAD, supporting previous conclusions regarding abnormal neurophysiological functions in psychiatric disorders and potentially leading to the identification of biomarkers for clinical diagnosis.

"It's knowing that there are other people and they've accepted it": Patients' experiences of an acceptance and commitment therapy group intervention for people with neurological conditions

Individuals living with neurological conditions often face chronic issues including motor and sensory impairments and cognitive deficits. These challenges can lead to significant psychological difficulties, including anxiety, depression, and post-traumatic stress. Acceptance and Commitment Therapy (ACT) is a psychotherapeutic approach which aims to enhance psychological flexibility and acceptance while promoting behavioural change. Although ACT groups have shown promise in supporting individuals with neurological conditions, the evidence on patients' experiences of attending them is sparse. This project explored the experiences of individuals with a range of neurological conditions who had attended ACT group sessions as part of routine clinical practice, with the aim to refine future iterations of the intervention and enhancing patient care. Ten individual qualitative semi-structured interviews were carried out and the data were analysed thematically. Three overarching themes emerged from the analysis: (1) Initial Barriers to Group Attendance and Engagement; (2) Building an Environment of Acceptance; (3) Developing an ACT toolkit. Overall, the results showed that the ACT group intervention led participants to develop stronger emotional connectedness, better knowledge of their difficulties, more effective psychological skills, and different mindsets regarding their condition. Implications for the refinement of future ACT groups, neuropsychological service development, and clinical practice are discussed.

Differential alterations of structural network in temporal lobe epilepsy with different seizure types are associated with cognitive and psychiatric status

BACKGROUND

The fundamental pathophysiologic understanding of different seizure types in Temporal lobe epilepsy (TLE) remains unclear. This study aimed to assess the distinct alterations of structural network in TLE patients with different seizure types and their relationships with cognitive and psychiatric symptoms.

METHODS

Seventy-three patients with unilateral TLE, including 25 with uncontrolled focal to bilateral tonic-clonic seizures (FBTCS), 25 with controlled FBTCS and 23 with focal impaired awareness seizures (FIAS), as well as 26 healthy controls (HC), underwent the diffusion tensor imaging (DTI) scan. Network-based statistic (NBS) and graph theory analyses were employed to investigate the structural network and its topological properties. Partial correlation analyses were conducted to examine the relationships between clinical variables and disrupted network characteristics. Additionally, the support vector machine (SVM) algorithm was utilized for the classification of controlled and uncontrolled FBTCS.

RESULTS

Compared to HC, TLE seizure type subgroups presented differently aberrant SC within the frontostriatal network. Additionally, alterations in the rich club organization and global network metrics were observed only in FBTCS. Notably, a significant decrease in all nodal metrics of the right amygdala were observed within the uncontrolled FBTCS group compared to the other three groups. Additionally, the disrupted nodal properties were significantly correlated with the age of onset, duration of epilepsy and psychiatric symptoms in FBTCS. Furthermore, the classifier achieved notably high accuracy (98%) in distinguishing between controlled and uncontrolled FBTCS.

CONCLUSIONS

Our findings may contribute to elucidating the neuropathological mechanisms of different seizure types in TLE and their impacts on cognitive and psychiatric status. SVM algorithm combined with nodal properties holds promise for predicting the poor seizure control of FBTCS.

Psychiatric disorders in children and adolescents with temporal lobe epilepsy: A narrative review

People with epilepsy (PWE) are at higher risk of psychiatric disorders (PD), disability, and reduced quality of life than the general population, especially in childhood and adolescence and when seizures originate from the temporal lobe. Temporal Lobe Epilepsy (TLE) is the most common type of focal epilepsy and can be due to structural abnormalities, or non-lesional causes, such as genetic variants. The prevalence of PD is approximately 20%-30% in people with epilepsy in general, and from 40% up to 80% in people with TLE. A higher rate of anxiety and depression disorders has been observed in association with TLE than with extra-temporal epilepsy, or idiopathic generalized epilepsy, or other chronic diseases such as diabetes. However, while the association between psychopathology and TLE has been extensively assessed in adults, only a few studies have focused on its expression in children and adolescents. In this review, we describe the prevalence, characteristics, and risk factors for PD in people with epilepsy in general and with TLE, with a specific focus on the pediatric age. In addition, we provide insights into the current knowledge of the pathophysiological bases of psychiatric symptoms in children and adolescents with TLE. PLAIN LANGUAGE SUMMARY: This review examines the frequency and characteristics of psychiatric disorders in people with temporal lobe epilepsy, with a focus on children and adolescents. Similarly to adults, younger people with epilepsy have higher rates of psychiatric disorders, such as depression and anxiety, than healthy peers or children with other chronic illnesses such as diabetes and asthma. Contributing risk factors include epilepsy duration and severity, and the effects of antiseizure medications, as well as psychological challenges, sociocultural influences, and family dynamics. Psychiatric disorders associated with temporal lobe epilepsy are relatively frequent, probably in relation to the critical role that some limbic structures in the temporal lobe, such as the amygdala and hippocampus, play in regulating emotions and behavior.

Determinants of health-related quality of life of patients with focal epilepsy: A systematic literature review

OBJECTIVE

Focal epilepsy can have significant negative impacts on a person's health-related quality of life (HRQoL). Although studies have been published on HRQoL in persons with focal epilepsy (PWFE), determinants of HRQoL have not been comprehensively examined. This systematic literature review (SLR) queried existing literature to identify aspects associated with HRQoL in PWFE without focus on resective epilepsy surgery, with an interest in identifying modifiable determinants for medical/nonmedical interventions.

METHODS

This SLR was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted in PubMed and Google Scholar for articles published from January 1, 1900, to February 19, 2023, reporting on the association between HRQoL or employability and a range of demographic, psychosocial, or epilepsy-related factors and comorbidities in PWFE.

RESULTS

A total of 879 abstracts were identified, with 126 manuscripts reviewed and 37 studies selected for inclusion that quantified the relationship between HRQoL and the variable of interest by multivariate (N = 21) or univariate only (N = 15) methods; 10 multivariate models also included univariate data. In adjusted models, the most commonly examined determinants of HRQoL included depression (n = 15/21), number of antiseizure medications (ASMs; n = 13/21), seizure frequency (continuous seizure count, n = 11/21; seizure freedom, n = 5/21), anxiety (n = 10/21), duration of disease (n = 9/21), and cognition (n = 9/21). Depression, anxiety, and cognition were frequently seen as significant contributors to HRQoL when studied (14/15 [93%], 9/10 [90%], and 7/9 [78%], respectively). Among concepts studied less frequently, ASM severity/adverse event burden was significant each time examined (in 5/19 studies). Attainment of seizure freedom and employability was significant 75% (n = 3/4) and 72% (n = 5/7) of the time, respectively.

SIGNIFICANCE

Poor HRQoL in PWFE can be attributed to a multitude of factors, including depression, anxiety, factors in disease management, and employability. An unmet need remains in addressing elements associated with poor HRQoL in this population.

Therapeutic potential of the extract of giant millipede Telodeinopus Canaliculatus on epileptogenesis and associated anxiety-like behavior

The secretions of Telodeinopus canaliculatus, a giant millipede, are used in traditional medicine to treat epileptic seizures. Therefore, this work aimed to assess the antiepileptogenic- and anxiolytic-like effects of an extract of T. canaliculatu in mice. Forty-eight mice were divided into six groups of eight each and treated as follows: normal control group received distilled water (10 ml/kg, p.o.); negative control group received received distilled water (10 ml/kg, p.o.); positive control group received sodium valproate (300 mg/kg, p.o.); and test groups received with the extract (30, 50, and 70 mg/kg, p.o.). One hour later, all groups, except the normal control group (distilled water, 10 ml/kg, i.p.), received a daily dose of pentylenetetrazole (25 mg/kg, i.p) until the onset of tonic-clonic seizures on day 24. On day 26 of the experiment, anxious behaviors were assessed. The mice were subsequently sacrificed and brains were collected for neurochemical analyses. The extract (30, 50, 70 mg/kg, p.o.) reduced (p < 0.001) the seizure severity. It also increased the latencies to the onset of seizures. In the elevated plus maze, the extract (50 mg/kg) increased by 51% (p < 0.001) the time spent in the open arms. The extract (50 mg/kg) increased GABA concentration by 28% (p < 0.01) and 37% (p < 0.001) respectively in the hippocampus and amygdala. Moreover, the extract (30 mg/kg) decreased the concentration of malondialdehyde by 47% (p < 0.001) and 42% (p < 0.01) respectively in the same regions. The hydroethanolic extract of T. canaliculatus is endowed with antiepileptogenic and anxiolytic effects.

Sexual Dysfunction and Associated Psychiatric Comorbidities Impacting Quality of Life in Epilepsy: A Review of Literature

INTRODUCTION

 Epilepsy is caused by dysfunction in the brain, which is characterized by an enduring disposition for unprovoked seizures that reoccur often, along with the neurological, cognitive, psychological, and social effects of the condition, which are often managed with prolonged and sometimes lifelong medications that involve antiepileptic drugs (AEDs). To confirm the diagnosis of epilepsy, at least two unprovoked seizures occurring greater than 24 hours apart should be reported. This illness affects both children and adults. Patients with epilepsy are more likely to experience sexual dysfunction compared to the general population, which often leads to a poor quality of life. The pathophysiology involved consists of the impact of epilepsy and AEDs on the control of the hypothalamic-pituitary-gonadal axis, consequently resulting in a high risk of developing testicular or ovarian dysfunction, leading to sexual dysfunction in epilepsy patients.

AIM

 This review aims to highlight various studies focusing on the association of developing the risk of sexual dysfunction with psychiatric comorbidities, mainly depression and anxiety, that impact the quality of life in epilepsy patients.

METHODOLOGY

 The search methodology involved articles from the Google Scholar and PubMed databases published between 2018 and 2023. "Sexual dysfunction", "epilepsy", "depression", "anxiety", and "quality of life" were the keywords used to search the articles. The Boolean operator "AND" and "OR" were used in between the keywords used. Following this, a total of 15 articles were included in the review based on the inclusion and exclusion criteria.

CONCLUSION

 The review concluded that epilepsy patients are often affected by sexual dysfunction along with associated psychiatric comorbidities that mainly involve depression and anxiety, consequently impacting their quality of life, as demonstrated by various studies. Sexual dysfunction is a common yet underdiagnosed condition in epilepsy patients due to the stigma attached to it. Hence, neurologists must keep a high index of suspicion for this problem. Furthermore, screening and monitoring for sexual dysfunction should be added to the usual epilepsy work-up.

Seizure-related stress and arousal responses mediate a relationship between anxiety trait and state in epilepsy

BACKGROUND

Epilepsy causes substantial psychological distress and anxiety, primarily due to seizures. However, the impact of stress responses and changes in arousal and their association with anxiety patterns in patients with epilepsy (PWE) remains unclear. This study aimed to investigate the relationships among seizures, stress and arousal characteristics, and trait and state anxiety characteristics in PWE.

METHODS

Our sample consisted of 159 outpatients with epilepsy recruited from five institutions in Japan in 2020. Participants completed the State-Trait Anxiety Inventory-Form JYZ (STAI) and the Japanese-Stress Arousal Check List (J-SACL). We analyzed the correlations between inventory scores and clinical information. Using principal component analysis (PCA), we derived epilepsy-specific stress/arousal characteristics, which accounted for high arousal and low-stress levels, termed epilepsy-specific stress or arousal response (ESAR), from the J-SACL scores. We conducted a mediation analysis to assess the mediating role of ESAR in the relationship between traits and state anxiety.

RESULTS

We found significant correlations between J-SACL stress and arousal factors (r = -0.845, p < 0.001), ESAR and seizure frequency (r = -0.29, p < 0.001), ESAR and trait anxiety scores on the STAI (r = -0.77, p < 0.0001), and ESAR and state anxiety scores on the STAI (r = -0.60, p < 0.0001). Mediation analysis supported by the Monte Carlo method revealed that ESAR significantly mediated the association between trait and state anxiety.

CONCLUSIONS

These findings elucidate the epilepsy-specific stress and arousal characteristics and their roles in mediating traits and state anxiety. These results may reflect the long-term clinical course and unique emotion recognition tendencies in epilepsy.

Stress phenotypes in epilepsy: impact on cognitive functioning and quality of life

Introduction

Drug-resistant epilepsy has been proposed as a chronic stress model. Stress can be measured in terms of chronicity (epilepsy duration) and intensity (comorbidities), with depression and anxiety among the most important comorbidities in epilepsy due to its prevalence and its relationship with cognitive functioning and quality of life. This study aims to establish phenotypes according to how patients face a stressful condition (epilepsy) and examine differences in cognition and quality of life depending on these phenotypes. We hypothesize that there will be an interrelationship between epilepsy duration and negative affectivity, and these variables will influence cognition and quality of life.

Methods

170 patients (82 men and 88 women) underwent a neuropsychological evaluation in which trait anxiety, depression, attention and executive function, verbal and visual memory, language, emotional recognition, and quality of life were assessed. Hierarchical clustering was performed using z-scores for three variables: trait anxiety; depression; and epilepsy duration.

Results

Three clusters were found: vulnerable (high negative affectivity and short duration); resilient (moderate negative affectivity and long duration); and low-impact group (low negative affectivity and short duration). Results show that the vulnerable group had poorer cognitive functioning and quality of life than the other groups. Specifically, the vulnerable group had poorer scores than the low-impact group on verbal memory, visual confrontation naming, and quality of life (except seizure worry). Furthermore, resilient patients had better scores than the low-impact group on cognitive flexibility variables, but lower scores on some quality-of-life subscales (i.e., overall quality of life, emotional well-being, and energy). Finally, the vulnerable group had poorer scores than the resilient group in executive functioning, naming, and quality of life.

Discussion

These results suggest that dealing with stress in patients with epilepsy is related to cognitive performance and quality of life. These findings underline the relevance of considering comorbidities in epilepsy and may be useful for detecting vulnerable or resilient profiles as risk or protective factors for cognitive and quality of life decline.

An aqueous extract of Syzygium cumini protects against kainate-induced status epilepticus and amnesia: evidence for antioxidant and anti-inflammatory intervention

Temporal lobe epilepsy is the most common drug-resistant epilepsy. To cure epilepsy, drugs must target the mechanisms at the origin of seizures. Thus, the present investigation aimed to evaluate the antiepileptic- and anti-amnesic-like effects of an aqueous extract of Syzygium cumini against kainate-induced status epilepticus in mice, and possible mechanisms of action. Mice were divided into 7 groups and treated as follows: normal group or kainate group received po distilled water (10 mL/kg), four test groups received Syzygium cumini (28.8, 72, 144, and 288 mg/kg, po), and the positive control group treated intraperitoneally (ip) with sodium valproate (300 mg/kg). An extra group of normal mice was treated with piracetam (200 mg/kg, po). Treatments were administered 60 min before the induction of status epilepticus with kainate (15 mg/kg, ip), and continued daily throughout behavioral testing. Twenty-four hours after the induction, T-maze and Morris water maze tasks were successively performed. The animals were then sacrificed and some markers of oxidative stress and neuroinflammation were estimated in the hippocampus. The extract significantly prevented status epilepticus and mortality. In the T-maze, the aqueous extract markedly increased the time spent and the number of entries in the discriminated arm. In the Morris water maze, the extract significantly increased the time spent in the target quadrant during the retention phase. Furthermore, the aqueous extract induced a significant reduction of oxidative stress and neuroinflammation. These results suggest that the aqueous extract of Syzygium cumini has antiepileptic- and anti-amnesic-like effects, likely mediated in part by antioxidant and anti-inflammatory activities.

Assessment of Anxiety in Patients With Epilepsy: A Literature Review

Objective

Approximately 20% of people with epilepsy (PWE) suffer from anxiety. These fears are quite diverse and may manifest periictally or interictally, be part of the seizure's semiology, or an expression of reactive psychological distress from seizures themselves. Our review addresses the question of what screening tools are used in clinical care and epileptological research to capture the complexity of epilepsy-specific anxieties.

Method

On 2021/11/11, we entered a search string in PubMed that covered our research interest as completely as possible. We also screened the bibliographies of our findings and followed PubMed's recommendations. From the assessments we found in the included studies, we extracted domains that represent the range of manifestations of anxiety, in order to compare the tools and to discuss to what extent they are suitable for assessing epilepsy-specific anxieties.

Results

We screened 1,621 abstracts. In total, we identified 24 different anxiety assessments. In addition to the psychiatric assessments in use, we found 7 tools that were designed to assess epilepsy-specific anxieties. The latter focus on different aspects of epilepsy-specific anxieties. In some cases, the conceptual frameworks are not sufficiently transparent or divergent.

Conclusion

Because a diagnosis of epilepsy can result in, or seizures may appear as, anxiety, it is important to better understand this psychological burden and address it therapeutically, if necessary. There is a need for screening tools that integrate specific points of a variety of assessments, so as to cover the broad range of epilepsy-specific fears. None of the assessments we found meets this integrative perspective. At the same time, the appropriate design of such a required tool presupposes a conceptual framework of what should be considered as epilepsy-specific anxiety.

An aqueous extract of Khaya senegalensis (Desv.) A. Juss. (Meliaceae) prevents seizures and reduces anxiety in kainate-treated rats: modulation of GABA neurotransmission, oxidative stress, and neuronal loss in the hippocampus

Ethnopharmacological relevance

Temporal lobe epilepsy is the most common form of drug-resistant epilepsy. Therefore, medicinal plants provide an alternative source for the discovery of new antiepileptic drugs.

Aim of the study

This study was aimed at investigating the antiepileptic- and anxiolytic-like effects of an aqueous extract of Khaya senegalensis (K. senegalensis) in kainate-treated rats.

Methods

Seventy-two rats received a single dose of kainate (12 mg/kg) intraperitoneally. Those that exhibited two hours of status epilepticus were selected and monitored for the first spontaneous seizure. Then, animals that developed seizures were divided into 6 groups of 8 rats each and treated twice daily for 14 days as follows: negative control group received per os (p.o.) distilled water (10 ml/kg); two positive control groups received either sodium valproate (300 mg/kg, p.o.) or phenobarbital (20 mg/kg, p.o.); and three test groups received different doses of the extract (50, 100, and 200 mg/kg, p.o.). In addition, a group of 8 normal rats (normal control group) received distilled water (10 ml/kg, p.o.). During the treatment period, the animals were video-monitored 12 h/day for behavioral seizures. At the end of the treatment period, animals were subjected to elevated plus-maze and open field tests. Thereafter, rats were euthanized for the analysis of γ-aminobutyric acid (GABA) concentration, oxidative stress status, and neuronal loss in the hippocampus.

Results

The aqueous extract of K. senegalensis significantly reduced spontaneous recurrent seizures (generalized tonic-clonic seizures) and anxiety-like behavior compared to the negative control group. These effects were more marked than those of sodium valproate or phenobarbital. Furthermore, the extract significantly increased GABA concentration, alleviated oxidative stress, and mitigated neuronal loss in the dentate gyrus of the hippocampus.

Conclusion

These findings suggest that the aqueous extract of K. senegalensis possesses antiepileptic- and anxiolytic-like effects. These effects were greater than those of sodium valproate or phenobarbital, standard antiepileptic drugs. Furthermore, these effects are accompanied by neuromodulatory and antioxidant activities that may be related to their behavioral effects. These data justify further studies to identify the bioactive molecules present in the extract for possible future therapeutic development and to unravel their mechanisms of action.

Changes in the quality of life of persons with epilepsy, after the implementation of an occupational therapy intervention with drama activities

PURPOSE

Epilepsy is a chronic disorder that affects all domains of daily living. Especially, in the case of drug resistance, it is usually associated with impairment of quality of life (QOL). The opportunity to self-express is crucial for maintaining mental health. Therefore, many non-pharmaceutical interventions have been utilized to relieve psychiatric symptoms, such as fear, anxiety, and depression in persons with epilepsy. In this study, we aimed to investigate the effect of the occupational therapy program with drama activities (ODTA) on the QOL of patients with epilepsy.

METHODS

In total, 15 patients with epilepsy from the region of Thrace, Greece, were enrolled in a 3-month OTDA program focusing on the relief of anxiety symptoms and self-regulation. Each patient's QOL was measured using the Quality of Life in Epilepsy Inventory (QOLIE-31) mean scores. The reliability change index was calculated and the Wilcoxon paired test was used to determine QOL changes post-intervention compared to pre-intervention.

RESULTS

Statistically significant improvements were observed in fear of having a seizure (p =.004), overall quality (p =.001), emotional well-being (p =.004), energy fatigue (p =.014), and total QOLIE (p =.001) score after the intervention. The changes in the QOLIE score were more prominent among female individuals (male vs female: p =.028 vs p =.008).

CONCLUSION

This study highlights the importance of providing an ODTA program in patients with epilepsy and proposes its broader combined application as a complementary intervention in such patients.

Perception of seizure severity and bothersome in refractory focal epilepsy

INTRODUCTION

A better understanding of the perception of the severity and bothersome caused by seizure phases (warning, ictal, and postictal phases) can contribute to the orientation strategies for adult people with epilepsy (PWEs).

OBJECTIVE

To assess the seizure severity and bothersome and relate them to the clinical aspects of epilepsy and quality of life (QoL).

METHODS

The Seizure Severity Questionnaire (SSQ) was associated with clinical variables and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the QOLIE-31 of 98 PWEs, with a significance level of P<0.05.

RESULTS

Most patients reported that seizure warnings helped them prepare for the event, with the postictal phase was the most bother symptom. Higher scores on the SSQ were associated with movements in the ictal phase, a prolonged duration, and the presence of mental and physical effects in the postictal phase. No difference was found in the SSQ, according to the seizure type and frequency. There was an association between the NDDI-E>15 and the SSQ. Higher scores on the SSQ were significantly related to an NDDI-E>15 (P=0.013), in the linear regression model. Seizure severity and bothersome compromise the perception of QoL.

CONCLUSION

The SSQ was useful in the assessment of the perception of seizure severity in PWEs. The postictal phase was the most bothersome one. The perception of seizure severity is associated with the presence of depression. Seizure severity correlates inversely with QoL.

Psychiatric disorders, depression and quality of life in patients with psychogenic non-epileptic seizures and drug resistant epilepsy living in Argentina

OBJECTIVES

Psychiatric disorders are frequently found in both patients with PNES and DRE, making the differential diagnosis even more complex. The aim of this study was to analyze and compare psychiatric aspects and the quality of life in patients with psychogenic non-epileptic seizures (PNES) and drug resistant epilepsy (DRE).

METHODS

Patients admitted to video-electroencephalograpy (VEEG) unit with confirmed PNES and DRE were included. Demographical characteristics, psychiatric diagnosis according to SCID I and II of DSM IV, pharmacological treatment, general functioning measured with GAF (Global assessment of functionality), quality of life (QoL) using QlesQSF (Quality of Life Enjoyment and Satisfaction Questionnaire Short Form) and depression severity using BDI II (Beck depression inventory), were compared between the groups. Non-parametric tests, chi square test, and logistic regression were used for statistical analysis.

RESULTS

148 patients consecutively admitted to VEEG were included (DRE n = 97; PNES n = 51). Somatization disorder (RR: 13.02, 95% CI: 1.23-137.39, p = 0.03) and a history of trauma (RR: 8.66, 95% CI: 3.21-23.31, p = 0.001) were associated with PNES. The QlesQ score and the GAF score were lower with a higher prevalence of suicide attempts in the PNES group (p < 0.01). A negative correlation was observed between the severity of depression and the quality of life (DRE r = - 0.28, p = 0.013; PNES r = - 0.59, p = 0.001).

CONCLUSIONS

Higher psychiatric comorbidity with poorer QoL were found in PNES patients compared to DRE. However, depression comorbidity negatively affected the QoL in both groups. Future studies based on illness perception will be orientated to complete this analysis.