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İşcan Ayyildiz N, Bingöl N. The effects of web-based animation-supported progressive relaxation exercises applied to individuals with epilepsy on fatigue and sleep quality: A randomized controlled study. Epilepsy Behav 2024; 154:109734. [PMID: 38554645 DOI: 10.1016/j.yebeh.2024.109734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/09/2024] [Accepted: 03/03/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE The study was conducted to determine the effects of Progressive Relaxation Exercise, supported by mobile-based animation, on fatigue and sleep quality of individuals with epilepsy. MATERIAL-METHOD The study was conducted in a randomized controlled design with a pretest-posttest model on epileptic individuals who applied to Giresun University, Faculty of Medicine, Neurology Outpatient Clinic between February and December 2022. By using power analysis, the sample of the study was determined as 60 epilepsy patients (30 in the Control Group, 30 in the Experimental Group). The data were collected by face-to-face interview technique with the Personal Information Form, Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS). Frequencies, percentages, arithmetic mean, standard deviations, Pearson Correlation Analysis, Paired t-Test, Student's t-Test, and Chi-Square Test were used in the evaluation of the study data. RESULTS When the Control Group's mean scores in the pre-test and post-tests, which were performed with an interval of 6 weeks, were compared, a statistically significant difference was detected between the FSS and PSQI scores (p>0.05). The mean Fatigue Severity Scale score was found to be 5.24 ± 0.69 before the Progressive Relaxation Exercises and 3.82 ± 0.77 after the exercises. The mean scores of the individuals on the Fatigue Severity Scale after the relaxation exercises were found to be lower at a statistically significant level than the mean scores before the relaxation exercises (p<0.001). The differences between subjective sleep quality (p<0.001), sleep latency (p<0.001), daytime dysfunction (p<0.001), and total sleep quality (p<0.001) score averages after the Progressive Relaxation Exercises were statistically significant compared to the pre-exercises status. When the post-test scores of the participants in the Experimental Group was examined, significant, moderate, and positive differences were detected between the FSS and Total PSQI scores (r: 0.373-p: 0.042), Subjective Sleep Quality (r: 0.487-p: 0.006), which is one of the sub-dimensions of PSQI, Sleeping Pill Use (r: 0.531-p: 0.003), and Daytime Dysfunction (r: 0.461-p: 0.01) scores. CONCLUSION It was determined that individuals with epilepsy experience fatigue and deterioration in sleep quality and there is a reciprocal relationship between the severity of fatigue and sleep quality in these individuals. Progressive Relaxation Exercises applied with the animation-supported web-based mobile intervention technique reduce the fatigue levels of individuals and increase sleep quality.
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Affiliation(s)
| | - Nuray Bingöl
- Department of Medical Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey.
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Samarasekera S. Managing patients with intellectual disability and epilepsy in the acute medical setting. Clin Med (Lond) 2024; 24:100039. [PMID: 38583804 PMCID: PMC11066991 DOI: 10.1016/j.clinme.2024.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Shanika Samarasekera
- Department of Neurology, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom.
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Nakamura H, Sugihara G, Hara K, Inaji M, Noha M, Takumi I, Watanabe M, Takahashi H, Maehara T, Yamamoto H, Takagi S. Seizure-related stress and arousal responses mediate a relationship between anxiety trait and state in epilepsy. Epilepsy Behav 2023; 147:109442. [PMID: 37716325 DOI: 10.1016/j.yebeh.2023.109442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
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.
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Affiliation(s)
- Hironobu Nakamura
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Hara Clinic, Kanagawa, Japan
| | - Genichi Sugihara
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Keiko Hara
- Hara Clinic, Kanagawa, Japan; Department of Respiratory and Nervous System Science, Biomedical Laboratory Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Noha
- Department of Neurosurgery, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Ichiro Takumi
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitoshi Yamamoto
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shunsuke Takagi
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Sleep Research Institute, Waseda University, 513 Waseda-Tsurumakicho, Shinjuku, Tokyo 162-0041 Japan.
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Assenza G, Sancetta BM, Lanzone J, Narducci F, Ricci L, Boscarino M, Marrelli A, Ciuffini R, Piccioli M, Di Lazzaro V, Tombini M. Resilience predicts and modulates anxiety severity in people with epilepsy. Epilepsy Behav 2023; 147:109390. [PMID: 37619458 DOI: 10.1016/j.yebeh.2023.109390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Anxiety is one of the most relevant psychiatric comorbidities in people with epilepsy (PwE). The role of resilience (RES) in the development of anxiety is not well understood. We purposed to better characterize RES impact on anxiety severity in PwE. MATERIALS AND METHODS One hundred and seventy-six PwE underwent online surveys including a collection of socio-demographic, seizure-related, and psychological variables. PwE were grouped according to the data collected; anxiety levels were compared through non-parametric statistics. Hierarchical regression analysis (HRA) and logistic regression were performed to characterize RES contribute in predicting the presence and the severity of anxiety. Mediation/moderation analysis was performed to evaluate causal effects among RES, depression, and anxiety. RESULTS Anxiety did not differ according to socio-demographic and seizure-related variables, exemption for the presence of drug-related adverse effects. Depression, RES, and sleep quality provided the major contribute on anxiety variance. The addiction of RES level in HRA and logistic regression provided a significant increase of R-squared value (p-value = 0.02) and of area under the curve (p-value = 0.03), respectively. RES modulated depression/anxiety relationship (p-value < 0.001), whereas depression did not mediate RES/anxiety correlation (p-value = 0.68). CONCLUSIONS We demonstrated that RES is a significant independent predictor of anxiety in PwE and is able to modulate depression impact on anxiety. Moreover, we confirmed the relevance of depression and sleep quality on anxiety severity.
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Affiliation(s)
- G Assenza
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - B M Sancetta
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
| | - J Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - F Narducci
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - L Ricci
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - M Boscarino
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - A Marrelli
- UOC Neurophysiopathology, Ospedale San Salvatore, L'Aquila, Italy
| | - R Ciuffini
- Department of MeSVA, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - M Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - V Di Lazzaro
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - M Tombini
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Berteotti C, Calvello C, Liguori C. Role of the orexin system in the bidirectional relation between sleep and epilepsy: New chances for patients with epilepsy by the antagonism to orexin receptors? Epilepsia 2023; 64:1991-2005. [PMID: 37212716 DOI: 10.1111/epi.17661] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 05/23/2023]
Abstract
Epilepsy is a common neurological disorder, affecting patients of all ages, reducing the quality of life, and associated with several comorbidities. Sleep impairment is a frequent condition in patients with epilepsy (PWE), and the relation between sleep and epilepsy has been considered bidirectional, as one can significantly influence the other, and vice versa. The orexin system was described more than 20 years ago and is implicated in several neurobiological functions other than in controlling the sleep-wake cycle. Considering the relation between epilepsy and sleep, and the significant contribution of the orexin system in regulating the sleep-wake cycle, it is conceivable that the orexin system may be affected in PWE. Preclinical studies investigated the impact of the orexin system on epileptogenesis and the effect of orexin antagonism on seizures in animal models. Conversely, clinical studies are few and propose heterogeneous results also considering the different methodological approaches to orexin levels quantification (cerebrospinal-fluid or blood samples). Because orexin system activity can be modulated by sleep, and considering the sleep impairment documented in PWE, the recently approved dual orexin receptor antagonists (DORAs) have been suggested for treating sleep impairment and insomnia in PWE. Accordingly, sleep improvement can be a therapeutic strategy for reducing seizures and better managing epilepsy. The present review analyzes the preclinical and clinical evidence linking the orexin system to epilepsy, and hypothesizes a model in which the antagonism to the orexin system by DORAs can improve epilepsy by both a direct and a sleep-mediated (indirect) effect.
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Affiliation(s)
- Chiara Berteotti
- Physiological Regulation in Sleeping Mice Lab, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Carmen Calvello
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Epilepsy Center, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
- Sleep Medicine Center, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
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Kandeda AK, Nodeina S, Mabou ST. An aqueous extract of Syzygium cumini protects against kainate-induced status epilepticus and amnesia: evidence for antioxidant and anti-inflammatory intervention. Metab Brain Dis 2022; 37:2581-2602. [PMID: 35916986 DOI: 10.1007/s11011-022-01052-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/12/2022] [Indexed: 10/16/2022]
Abstract
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.
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Affiliation(s)
- Antoine Kavaye Kandeda
- Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon.
- Department of Animal Biology and Physiology, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon.
| | - Saleh Nodeina
- Department of Biological Sciences, Faculty of Science, University of Ngaoundéré, P.O. Box 454, Ngaoundéré, Cameroon
| | - Symphorien Talom Mabou
- Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
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Research on Motion Behavior and Quality-of-Life Health Promotion Strategy Based on Bee Colony Optimization. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2222394. [PMID: 35281534 PMCID: PMC8916874 DOI: 10.1155/2022/2222394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/26/2022] [Indexed: 01/23/2023]
Abstract
Quality of life is a kind of sensory experience of people's physical health, social ability, and personal overall situation. Correct understanding and evaluation of the quality of life is conducive to human rational planning and control of life resources, promote physical and mental health, and improve the quality of life. In order to further explain the positive impact of physical exercise behavior on promoting physical and mental health, based on the bee colony optimization algorithm this paper analyzes the relationship between physical exercise behavior and quality of life and discusses the role of physical exercise behavior in promoting physical and mental health. The essential attributes and sociological significance of sports determine that sports play a unique role in providing people with social support. The quality of life score increases as the duration of the exercise increases. The theory and methods of defense and treatment advocated by sports thoughts will also have a positive effect on individuals avoiding and getting rid of mental illness. Teachers who have lower exercise time and frequency of exercise should also develop a step-by-step exercise program to strive to join them in the sports population.
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Tanveer M, Ahmed A, Iqbal M, Aslam F, Saqlain M, Ur Rehman I, Khurshid Hashmi F. Excessive Daytime Sleepiness and Sleep Quality and their Impact on Health-Related Quality of Life in People with Epilepsy: A study from Pakistan. Epilepsy Behav 2022; 128:108565. [PMID: 35104734 DOI: 10.1016/j.yebeh.2022.108565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epilepsy is one of the most common but manageable neurological disorder. The relation between epilepsy, sleep, and health-related quality of life (HRQoL) in culturally distinct environment of Pakistan remains unclear. The purpose of this study was to determine prevalence and predictors of excessive daytime sleepiness (EDS), poor sleep quality (SQ), and to analyze their association with HRQoL in people with epilepsy (PWE). METHODS A study was conducted among PWE attending two tertiary care hospitals of Islamabad and Rawalpindi, Pakistan. The EDS, SQ, and HRQoL were evaluated by Urdu versions of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31). RESULTS The study included 200 PWE and 51 healthy controls with mean (SD) ages of 33.1 ± 13.9, 32.9 ± 10.9, and a disease duration of 5.01 ± 6.17, respectively. The majority of the respondents (n = 130, 65%) had poor seizure control, and most of these (n = 88, 68%) were on combination antiepileptic drug (AED) therapy. In comparison to controls, a higher number of PWE had EDS by ESS (score ≥ 11, 10% vs. 40%, p-value 0.00), and poor SQ by PSQI (score > 5, 9% vs. 71%, p-value 0.00). A multiple logistic regression analysis reveals that the factors significantly associated with EDS were: female gender; increasing age; seizure control; duration of epilepsy; and combination AED therapy. A second multiple binary logistic regression analysis suggests that factors significantly associated with poor SQ were: increasing age; female gender; poor seizure control; and combination therapy. The Hierarchical multivariate analysis suggests that poor seizure control, EDS, and poor SQ were significant predictors of low HRQoL. CONCLUSION The findings suggest high prevalence of EDS and poor SQ in PWE in Pakistan. A significant negative association exists between sleep complaints and HRQoL. During routine clinical consultations, awareness about sleep hygiene practices must be provided to enhance HRQoL.
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Affiliation(s)
- Maria Tanveer
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, Pakistan.
| | - Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia
| | - Mansoor Iqbal
- Neurology Department, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Faiza Aslam
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan
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Godoy LD, Prizon T, Rossignoli MT, Leite JP, Liberato JL. Parvalbumin Role in Epilepsy and Psychiatric Comorbidities: From Mechanism to Intervention. Front Integr Neurosci 2022; 16:765324. [PMID: 35250498 PMCID: PMC8891758 DOI: 10.3389/fnint.2022.765324] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/24/2022] [Indexed: 12/22/2022] Open
Abstract
Parvalbumin is a calcium-binding protein present in inhibitory interneurons that play an essential role in regulating many physiological processes, such as intracellular signaling and synaptic transmission. Changes in parvalbumin expression are deeply related to epilepsy, which is considered one of the most disabling neuropathologies. Epilepsy is a complex multi-factor group of disorders characterized by periods of hypersynchronous activity and hyperexcitability within brain networks. In this scenario, inhibitory neurotransmission dysfunction in modulating excitatory transmission related to the loss of subsets of parvalbumin-expressing inhibitory interneuron may have a prominent role in disrupted excitability. Some studies also reported that parvalbumin-positive interneurons altered function might contribute to psychiatric comorbidities associated with epilepsy, such as depression, anxiety, and psychosis. Understanding the epileptogenic process and comorbidities associated with epilepsy have significantly advanced through preclinical and clinical investigation. In this review, evidence from parvalbumin altered function in epilepsy and associated psychiatric comorbidities were explored with a translational perspective. Some advances in potential therapeutic interventions are highlighted, from current antiepileptic and neuroprotective drugs to cutting edge modulation of parvalbumin subpopulations using optogenetics, designer receptors exclusively activated by designer drugs (DREADD) techniques, transcranial magnetic stimulation, genome engineering, and cell grafting. Creating new perspectives on mechanisms and therapeutic strategies is valuable for understanding the pathophysiology of epilepsy and its psychiatric comorbidities and improving efficiency in clinical intervention.
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Affiliation(s)
- Lívea Dornela Godoy
- Department of Psychology, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Tamiris Prizon
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Matheus Teixeira Rossignoli
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Pereira Leite
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- João Pereira Leite,
| | - José Luiz Liberato
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- *Correspondence: José Luiz Liberato,
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Yin Q, Chen A, Song X, Deng G, Dong W. Risk Perception and PTSD Symptoms of Medical Staff Combating Against COVID-19: A PLS Structural Equation Model. Front Psychiatry 2021; 12:607612. [PMID: 33658951 PMCID: PMC7917132 DOI: 10.3389/fpsyt.2021.607612] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Medical staff were battling against coronavirus disease 2019 (COVID-19) at the expense of their physical and mental health, particularly at risk for posttraumatic stress disorder (PTSD). In this case, intervening PTSD of medical staff and preparing them for future outbreaks are important. Previous studies showed that perceived stress was related to the development of PTSD. Hence, in this study, the association between risk perception of medical staff and PTSD symptoms in COVID-19 and the potential links were explored. Three hundred four medical staff's exposure to COVID-19 patients, risk perception for working during COVID-19, PTSD symptoms, anxiety, and sleep quality were measured. Mediation analysis tested the indirect effects of anxiety and sleep quality on the relationship between risk perceptions and PTSD symptoms; 27.6% of participants were deemed as having probable PTSD diagnosis. Mediation analysis showed a significant chain-mediating effect of anxiety and sleep quality on the relationships between risk perceptions and PTSD symptoms; higher risk perceptions were related to increased anxiety, worsened sleep quality, and severe PTSD symptoms. Conclusively, medical staff have a high prevalence of PTSD symptoms after 3 months of COVID-19. Their PTSD symptoms were associated with the perceived risk level through the potential links with anxiety and sleep quality. Therefore, risk perception could be critical for our medical staff's responses to public health emergencies. It could be plausible to intervene in the perceived stress to alleviate aroused anxiety and improve sleep quality and thereby deter the development of PTSD.
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Affiliation(s)
- Qianlan Yin
- Department of Naval Aviation and Operational Psychology, Navy Medical University, Shanghai, China
| | - Aibin Chen
- Department of Naval Aviation and Operational Psychology, Navy Medical University, Shanghai, China
| | - Xiangrui Song
- Department of Naval Aviation and Operational Psychology, Navy Medical University, Shanghai, China
| | - Guanghui Deng
- Department of Naval Aviation and Operational Psychology, Navy Medical University, Shanghai, China
| | - Wei Dong
- Department of Naval Aviation and Operational Psychology, Navy Medical University, Shanghai, China
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Paiva ML, Lima EM, Siqueira IB, Rzezak P, Koike C, Moschetta SP, Vincentiis S, Alessi R, Khafif TC, Mendoza M, Valente KD. Seizure control and anxiety: Which factor plays a major role in social adjustment in patients with Juvenile Myoclonic Epilepsy? Seizure 2020; 80:234-239. [PMID: 32663782 DOI: 10.1016/j.seizure.2020.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aimed to determine the presence of anxiety disorder and severity of anxiety symptoms in an extensive series of consecutive patients with JME and its association with epilepsy-related factors. In addition, we evaluated the impact of anxiety and clinical variables on social adjustment. METHODS We prospectively evaluated 112 (56.2 % females, mean age 27.2 years) patients with an electroclinical diagnosis of JME and 61 (52.4 % females, mean age 29.3 years) healthy controls. Anxiety symptoms were assessed by the State and Trait Anxiety Inventory (STAI). Social functioning was addressed with Self-Report Social Adjustment Scale (SAS). The patient group was also evaluated with a psychiatric interview. RESULTS Patients with JME presented more severe anxiety symptoms and worse social adjustment compared with controls. The presence of anxiety disorder and the severity of anxiety symptoms was associated with frequent seizures - generalized tonic-clonic seizures (p = 0.008) and drug-resistant epilepsy (p = 0.021). Regarding social adjustment, the severity of anxiety symptoms was associated with lower economic adjustment (p = 0.039), while the presence of anxiety disorder impacted family relationships (p 0.025). The presence of hard-to-control myoclonic seizure was associated with lower scores on work (p = 0.019), leisure activities (p = 0.008), family relationship (p = 0.022) and overall social adjustment (p = 0.038). CONCLUSION Patients with JME have severe anxiety symptoms and worse social adjustment. Anxiety disorder and symptoms were associated with frequent seizures and drug-resistant epilepsy. Epilepsy-related factors and anxiety impaired distinct aspects of social functioning.
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Affiliation(s)
- Maria Luisa Paiva
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Ellen Marise Lima
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Isabelle Bimbatti Siqueira
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Patricia Rzezak
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Camila Koike
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Sylvie P Moschetta
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Silvia Vincentiis
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Rudá Alessi
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Tatiana Cohab Khafif
- Bipolar Disorder Program, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Melanie Mendoza
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil.
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12
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Marzola E, Fassino S, Migliaretti G, Abbate-Daga G, Kaye WH. Development and validation of the Premorbid Childhood Traits Questionnaire (PCT-Q) in eating disorders. Eat Weight Disord 2019; 24:815-823. [PMID: 31313252 DOI: 10.1007/s40519-019-00748-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/04/2019] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Some features of eating disorders (EDs) are often present in childhood before the onset of the ED. We developed a novel questionnaire to retrospectively capture such childhood traits. METHODS Focus groups were conducted at the University of California-San Diego, USA, and at the University of Turin, Italy. Three focus groups were conducted at each site, interviewing patients and parents to identify those traits that most commonly characterize childhood of patients with EDs. A preliminary version of the Premorbid Childhood Traits Questionnaire (PCT-Q) derived from these focus groups was then administered to 94 consecutive inpatients with an ED and to 286 healthy controls (HCs) at the Turin site. Also, 208 participants' parents were enrolled as well; in fact, the PCT-Q was developed with both a proband and an informant version. RESULTS A 37-item final version of the PCT-Q was generated. Reliability analyses suggested acceptability for harm avoidance (HA), social phobia, alexithymia, interoceptive awareness (IA), and food obsessions. Inter-rater reliability ranged from fair to moderate. ED sufferers scored significantly higher than HCs on HA, social phobia, alexithymia, IA, and food obsessions. CONCLUSIONS These findings support the possibility that premorbid traits contribute to a risk to develop an ED in some individuals. LEVEL OF EVIDENCE III: case-control analytic study.
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Affiliation(s)
- Enrica Marzola
- Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy.
| | - Secondo Fassino
- Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Giuseppe Migliaretti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA, USA
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Henning O, Landmark CJ, Henning D, Nakken KO, Lossius MI. Challenges in epilepsy-The perspective of Norwegian epilepsy patients. Acta Neurol Scand 2019; 140:40-47. [PMID: 30963535 DOI: 10.1111/ane.13098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES For most people with epilepsy (PWE), problems that are not directly related to seizures may constitute major challenges in everyday life. The purpose of this study was to determine the extent of these challenges and any risk factors for their occurrence among PWE in Norway, based on the patients' own perspective. MATERIALS AND METHODS We used a web-based survey to ask PWE visiting the homepage of the Norwegian Epilepsy Association about different everyday challenges. A link to the survey was accessible via the members' homepage for a 4-month period during 2017. RESULTS One thousand one hundred eighty-two PWE responded to the questionnaire. Although more than 40% of the cohort reported that they had been seizure free for at least 1 year, the majority reported that tiredness (71%), memory problems (70%), concentration problems (68%), headache or vertigo (51%), and feeling depressed (59%) continued to represent challenges. In addition, fear of being alone, sexual problems or difficulties in social settings were reported by about one-third of the patients. Reporting having these challenges was significantly associated with female gender, polytherapy, experiencing seizures during the previous 12 months and feeling blue or depressed. CONCLUSIONS The results of this study, reflecting a self-selected Norwegian population, provide insights into the challenges not directly associated with seizures that impact on the quality of life of PWE. The impacts of such challenges may be underestimated as components of the entire burden of epilepsy.
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Affiliation(s)
- Oliver Henning
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
| | - Cecilie J. Landmark
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
- Section for Clinical Pharmacology, Department of Pharmacology Oslo University Hospital Oslo Norway
- Programme for Pharmacy, Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
| | - David Henning
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
| | - Karl O. Nakken
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
| | - Morten I. Lossius
- Division of Clinical Neuroscience, The National Centre for Epilepsy Oslo University Hospital Oslo Norway
- Medical Faculty University of Oslo Oslo Norway
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14
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Gutter T, Callenbach PM, Brouwer OF, de Weerd AW. Prevalence of sleep disturbances in people with epilepsy and the impact on quality of life: a survey in secondary care. Seizure 2019; 69:298-303. [DOI: 10.1016/j.seizure.2019.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022] Open
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Anxiety-like features and spatial memory problems as a consequence of hippocampal SV2A expression. PLoS One 2019; 14:e0217882. [PMID: 31166988 PMCID: PMC6550411 DOI: 10.1371/journal.pone.0217882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2019] [Indexed: 02/08/2023] Open
Abstract
The Synaptic Vesicle Protein 2A (SV2A) is a transmembrane protein whose presence is reduced both in animal models and in patients with chronic epilepsy. Besides its implication in the epileptic process, the behavioural consequences of the changes in its expression remain unclear. The purpose of our research is to better understand the possible role(s) of this protein through the phenotype of cKO (Grik4 Cre+/-, SV2A lox/lox) mice, male and female, which present a specific decrease of SV2A expression levels in the hippocampal glutamatergic neurons but without any epileptic seizures. In this study, we compare the cKO mice with cHZ (Grik4 Cre+/-, SV2A lox/+) and WT (Grik4 Cre+/+, SV2A lox/lox) mice through a battery of tests, used to evaluate different features: the anxiety-related features (Elevated Plus Maze), the locomotor activity (Activity Chambers), the contextual fear-related memory (Contextual Fear Conditioning), and the spatial memory (Barnes Maze). Our results showed statistically significant differences in the habituation to a new environment, an increase in the anxiety levels and spatial memory deficit in the cHZ and cKO groups, compared to the WT group. No statistically significant differences due to the genotype appeared in the spontaneous locomotor activity or the fear-linked memory. However, sexual differences were observed in this last feature. These results highlight not only an important role of the SV2A protein in the cognitive and anxiety problems typically encountered in epileptic patients, but also a possible role in the symptomatology of other neurodegenerative diseases, such as the Alzheimer’s disease.
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Taskiran E, Matur Z, Gül G, Bebek N, Baykan B, Gökyigit A, Gürses C. The Impact of Affective State on Quality of Life in Focal Epilepsy in Turkey. J Neurosci Rural Pract 2019; 10:267-272. [PMID: 31001016 PMCID: PMC6454954 DOI: 10.4103/jnrp.jnrp_324_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Seizures and accompanying situations including social, medical, and psychiatric problems threaten the quality of life (QOL) in patients with epilepsy. The World Health Organization defines health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Aims: This study examines the prevalence of both depression and anxiety symptoms and also impact of the affective state on QOL in patients with focal epilepsy in Turkey. Settings and Design: One hundred and five patients with focal epilepsy over 18 years old were included in this study. The patients were classified into four groups according to the presence of AS and seizure control. Subjects and Methods: Patients’ affective symptoms (AS) and QOL were examined using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and QOL in Epilepsy Inventory-31 (QOLIE-31). Statistical Analysis Used: We used descriptive statistics, Chi-square test, independent samples t-test, one-way analysis of variance, Mann–Whitney U-test, Kruskal–Wallis H-test, and also Pearson's and Spearman's correlation test for correlations. Results: There were positive correlations between total QOLIE-31 score and epilepsy surgery, employment, and seizure freedom, whereas negative correlations were found with antiepileptic drug use, anxiety, and depression. Statistically significant differences were found in QOLIE-31 totals and subscores between Groups 3 and 4 (P < 0.05). Conclusions: The presence of AS has a negative impact on QOL in patients with focal epilepsy. Physicians should be aware that psychiatric comorbidities in epilepsy have a severe impact and epilepsy treatment requires comprehensive management.
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Affiliation(s)
- Emine Taskiran
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Zeliha Matur
- Department of Neurology, Istanbul Bilim University Faculty of Medicine, Istanbul, Turkey
| | - Günay Gül
- Department of Neurology, Neurology Clinic, Bakirkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Istanbul, Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayşen Gökyigit
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Candan Gürses
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Wiglusz MS, Landowski J, Cubała WJ. Psychometric properties and diagnostic utility of the State-Trait Anxiety Inventory in epilepsy with and without comorbid anxiety disorder. Epilepsy Behav 2019; 92:221-225. [PMID: 30690323 DOI: 10.1016/j.yebeh.2019.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 12/28/2018] [Accepted: 01/04/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Anxiety disorders are frequent comorbid disorder in patients with epilepsy (PWEs). The availability of validated screening instruments to detect anxiety disorders in PWEs is limited. The aim of the present study was to validate State-Trait Anxiety Inventory (STAI) in adult PWEs for the detection of anxiety disorders. METHODS A total of 96 outpatients with epilepsy completed the self-report symptom scale and were diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision (DSM-IV-TR) Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the State-Trait Anxiety Inventory State (STAI-S) and State-Trait Anxiety Inventory Trait (STAI-T) anxiety subscales. RESULTS Receiver operating characteristic analyses for STAI-T showed area under the curve at 84.7%. For diagnoses of anxiety disorders, the STAI-T demonstrated the best psychometric properties for a cutoff score ≥ 52 with sensitivity of 81.3%, specificity of 77.5%, positive predictive value (PPV) of 41.9%, and negative predictive value (NPV) of 95.4%. CONCLUSIONS The STAI-T proved to be a valid and reliable psychometric instrument in terms of screening for anxiety disorders in PWEs. In the epilepsy setting, STAI-T maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing anxiety disorders with an optimum cutoff score ≥ 52.
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Affiliation(s)
- Mariusz S Wiglusz
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Poland.
| | - Jerzy Landowski
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Wiesław J Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Poland
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Baker DA, Caswell HL, Eccles FJR. Self-compassion and depression, anxiety, and resilience in adults with epilepsy. Epilepsy Behav 2019; 90:154-161. [PMID: 30557784 DOI: 10.1016/j.yebeh.2018.11.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Research suggests that people with epilepsy (PWE) are more likely to experience depression and anxiety than the general population. Given the adversity associated with the condition, resilience may also be important. However, to date, resilience has been largely overlooked in the epilepsy literature. Self-compassion has been widely associated with improved psychological wellbeing and, to a lesser extent, resilience. However, the relationship between self-compassion and depression, anxiety, and resilience in PWE has not been examined. OBJECTIVES Using a quantitative cross-sectional survey design, the aim of the present study was to examine the extent to which self-compassion predicted depression, anxiety, and resilience when controlling for demographic and illness-related variables. METHODS Adults with epilepsy were invited to take part in a survey online or in epilepsy or neurology clinics. Two-hundred and seventy participants completed the survey, and data were analyzed using hierarchical multiple regression models. RESULTS In this sample of PWE, self-compassion significantly predicted lower depression and anxiety and higher resilience when other significant sociodemographic and illness-related variables had been taken into account. CONCLUSIONS The findings of the present study indicate that self-compassion could be an important factor in determining psychological outcomes for adults with epilepsy, and its role is worthy of further exploration to help improve psychological outcomes for PWE.
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Affiliation(s)
- David A Baker
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, UK
| | - Helen L Caswell
- Department of Clinical Neuropsychology, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, UK.
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Knudsen-Baas KM, Johannesen TB, Myklebust TÅ, Aarseth JH, Owe JF, Gilhus NE, Storstein AM. Antiepileptic and psychiatric medication in a nationwide cohort of patients with glioma WHO grade II-IV. J Neurooncol 2018; 140:739-748. [PMID: 30471051 DOI: 10.1007/s11060-018-03007-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/20/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Glioma is the most common intracranial primary brain tumor. Patients with glioma often suffer from epilepsy, anxiety and depression. Aims of this study were to identify risk factors for drug-treated anxiety and depression, and to determine the use of psychiatric medication in a national glioma cohort. METHODS Data from the Cancer Registry of Norway on all persons diagnosed with glioma WHO grade II-IV 2004-2010 were linked with data from the Norwegian Prescription Database. Cox regression analysis was used to assess risk factors for drug-treated anxiety and depression. Standardized incidence ratios were calculated for psychiatric medication dispensed to glioma patients and compared to the general population. RESULTS The glioma cohort consisted of 1056 males and 772 females. Of the 1828 patients, 565 had glioma grade II-III, and 1263 had grade IV. The patients with glioma grade II-III who were treated with levetiracetam had an increased risk for drug-treated anxiety compared to patients without levetiracetam; hazard ratio 2.8 (95% confidence interval 1.7-4.9). Female gender increased the risk for drug-treated anxiety compared to males in patients with glioma grade IV; hazard ratio 1.5 (95% confidence interval 1.2-2.0). Antidepressants were less frequently dispensed to patients with glioma grade II-III and epilepsy than to the general population. CONCLUSIONS Patients with glioma grade II-III on levetiracetam had an increased risk for drug-treated anxiety. The subgroup of patients with glioma grade II-III and epilepsy received less antidepressants than the general population.
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Affiliation(s)
| | - Tom Børge Johannesen
- Department of Registration, Cancer Registry of Norway, Ullernchausseen 64, Oslo, 0379, Norway
| | - Tor Åge Myklebust
- Department of Registration, Cancer Registry of Norway, Ullernchausseen 64, Oslo, 0379, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Post Box 1600, 6026, Ålesund, Norway
| | - Jan Harald Aarseth
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Jone Furlund Owe
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Post Box 7804, 5020, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
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Chen YY, Huang S, Wu WY, Liu CR, Yang XY, Zhao HT, Wu LC, Tan LZ, Long LL, Xiao B. Associated and predictive factors of quality of life in patients with temporal lobe epilepsy. Epilepsy Behav 2018; 86:85-90. [PMID: 30017833 DOI: 10.1016/j.yebeh.2018.06.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/02/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Identifying the factors that are correlated with and predictive of reduced quality of life (QOL) is essential to optimize the treatment of epilepsy and the management of comorbidities. METHODS We analyzed the independent associations between the Quality of Life in Epilepsy-31 (QOLIE-31) inventory and the demographic, clinical, psychiatric, and cognitive variables of 47 consecutive patients with temporal lobe epilepsy (TLE). Predictors of the correlated variables were analyzed by multiple linear regression analysis. RESULTS The QOLIE-31 total score was positively correlated with occupational status and Mini-Mental State Examination (MMSE) scores (r = 0.290 and 0.295, respectively; P < 0.05) and negatively correlated with the duration of seizures, adverse effects of antiepileptic drugs (AEDs), and the Pittsburgh Sleep Quality Inventory (PSQI), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) scores (r = -0.357, 0.321, 0.328, -0.672, and -0.565, respectively; P < 0.05; P < 0.01 for the SAS and SDS). In the final multivariate regression model, anxiety, long durations of seizures, adverse effects of AEDs, and depression explained approximately 60.6% (adjusted R2 = 0.606, R coefficient = 0.800) of the QOLIE-31 overall score variance. CONCLUSION Anxiety, long durations of seizures, adverse effects of AEDs, and depression were significant predictors of QOL, and these variables had relatively high prediction capacities for the overall QOLIE-31 in the regression model. Comorbid anxiety is the most powerful negative determinant of the QOLIE-31.
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Affiliation(s)
- Ya-Yu Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Sha Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Wen-Yue Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Chao-Rong Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Xiao-Yan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Hai-Ting Zhao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Ling-Chao Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Lang-Zi Tan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Li-Li Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China.
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China.
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Kotwas I, McGonigal A, Bastien-Toniazzo M, Bartolomei F, Micoulaud-Franchi JA. Stress regulation in drug-resistant epilepsy. Epilepsy Behav 2017; 71:39-50. [PMID: 28494323 DOI: 10.1016/j.yebeh.2017.01.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/29/2016] [Accepted: 01/25/2017] [Indexed: 12/17/2022]
Abstract
The prevalence of psychological distress, especially depressive and anxiety disorders, is higher in epilepsy than in other chronic health conditions. These comorbid conditions contribute even more than epileptic seizures themselves to impaired quality of life in patients with epilepsy (PWE). The link between these comorbidities and epilepsy appears to have a neurobiological basis, which is at least partly mediated by stress through psychological and pathophysiological pathways. The impact of stress in PWE is also particularly important because it is the most frequently reported seizure trigger. It is therefore crucial for clinicians to take stress-related conditions and psychiatric comorbidities into account when managing PWE and to propose clinical support to enhance self-control of stress. Screening tools have been specially designed and validated in PWE for depressive disorders and anxiety disorders (e.g. NDDI-E, GAD-7). Other instruments are useful for measuring stress-related variables (e.g. SRRS, PSS, SCS, MHLCS, DSR-15, ERP-R, QOLIE-31) in order to help characterize the individual "stress profile" and thus orientate patients towards the most appropriate treatment. Management includes both pharmacological treatment and nonpharmacological methods for enhancing self-management of stress (e.g. mindfulness-based therapies, yoga, cognitive-behavioral therapies, biofeedback), which may not only protect against psychiatric comorbidities but also reduce seizure frequency.
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Affiliation(s)
- Iliana Kotwas
- Laboratoire Parole et Langage UMR 7309, Aix-Marseille Université, Marseille, France.
| | - Aileen McGonigal
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | | | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Jean-Arthur Micoulaud-Franchi
- Service d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de, Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, Université de Bordeaux, France
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Pembroke S, Higgins A, Pender N, Elliott N. Becoming comfortable with "my" epilepsy: Strategies that patients use in the journey from diagnosis to acceptance and disclosure. Epilepsy Behav 2017; 70:217-223. [PMID: 28437750 DOI: 10.1016/j.yebeh.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Proponents of resilience theory have highlighted the importance of understanding the processes of resilience. The objective of the study was to explore how people with epilepsy reach a stage of being comfortable with their epilepsy. Identifying the processes used is important to developing effective self-management for people who are newly diagnosed with epilepsy. METHOD A grounded theory approach involving forty-nine consenting adult people with epilepsy (18 years and over), was used to explore their first-hand experiences of coming to terms with their epilepsy. Data were collected using one-to-one interview to elicit in-depth personal accounts of people with epilepsy's experiences of adjusting to their diagnosis of epilepsy. Using grounded theory's systematic inductive-deductive process data of analysis, the core findings that emerged from the open coding and inductive phase were analyzed independently by two researchers to ensure that findings were verified and validated across the interview dataset. FINDINGS Three core categories emerged as central to the journey that people experience after receiving their diagnosis of epilepsy towards becoming comfortable with their epilepsy. These were: i) meaning of "my" epilepsy diagnosis, to capture people with epilepsy's feelings, reactions and concerns after being diagnosed with epilepsy, ii) useful strategies, to identify what people with epilepsy did to become comfortable with their diagnosis, and iii) being comfortable with my epilepsy, to account for the frame of mind of people with epilepsy when they reach a point of accepting their diagnosis. DISCUSSION The findings provide important insights into the personal experiences of people with epilepsy after receiving their diagnosis and identifies a range of strategies they find useful in helping them reach a position of acceptance and being 'comfortable with my epilepsy'.
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Affiliation(s)
- Sinead Pembroke
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Naomi Elliott
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
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Fishman J, Cohen G, Josephson C, Collier AM, Bharatham S, Zhang Y, Wild I. Patient emotions and perceptions of antiepileptic drug changes and titration during treatment for epilepsy. Epilepsy Behav 2017; 69:44-52. [PMID: 28222341 DOI: 10.1016/j.yebeh.2017.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the impact of antiepileptic drug (AED) change and dose titration on the emotional well-being of patients with epilepsy. METHODS Members of an online epilepsy community were invited to voluntarily participate in an online survey. The cross-sectional anonymous survey consisted of 31 multiple choice questions balanced in terms of variety and positivity/negativity of emotions concerning participants' most recent AED change. To substantiate survey results, spontaneous comments from epilepsy-related online forums and social media websites that mentioned participants' experiences with AED medication changes (termed passive listening statements) were analyzed and categorized by theme. RESULTS All 345 survey participants (270 [78.3%] female; 172 [49.9%] were 26-45years old) self-reported an epilepsy/seizure diagnosis and were currently taking seizure medication; 263 (76.2%) were taking ≥2 AEDs and 301 (87.2%) had ≥1 seizure in the previous 18months. All participants reported a medication change within the previous 12months (dose increased [153 participants (44.3%)], medication added [105 (30.4%)], dose decreased [49 (14.2%)], medication removed [38 (11.0%)]). Improving seizure control (247 [71.6%]) and adverse events (109 [31.6%]) were the most common reasons for medication change. Primary emotions most associated (≥10% of participants) with an AED regimen change were (before medication change; during/after medication change) hopefulness (50 [14.5%]; 43 [12.5%]), uncertainty (50 [14.5%]; 69 [20.0%]), and anxiety (35 [10.1%]; 45 [13.0%]), and were largely due to concerns whether the change would work (212/345 [61.4%]; 180/345 [52.2%]). In the text analysis segment aimed at validating the survey, 230 participants' passive listening statements about medication titration were analyzed; additional seizure activity during dose titration (93 [40.4%]), adverse events during titration (71 [30.9%]), higher medication dosages (33 [14.3%]), and drug costs (25 [10.9%]) were the most commonly noted concerns. CONCLUSION Although the emotional well-being of patients with epilepsy is complex, our study results suggest that participants report their emotional well-being as negatively affected by changes in AED regimen, with most patients reporting uncertainty regarding the outcome of such a change. Future research is warranted to explore approaches to alleviate patient concerns associated with AED medication changes.
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Affiliation(s)
- Jesse Fishman
- UCB Pharma, 1950 Lake Park Drive SE, Smyrna, GA 30080, USA.
| | - Greg Cohen
- UCB Pharma, 1950 Lake Park Drive SE, Smyrna, GA 30080, USA.
| | - Colin Josephson
- Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Foothills Medical Center, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada.
| | - Ann Marie Collier
- St Mary's Hospital, 750 Wellington Ave, Grand Junction, CO 81501, USA.
| | | | - Ying Zhang
- UCB Pharma, 1950 Lake Park Drive SE, Smyrna, GA 30080, USA.
| | - Imane Wild
- UCB Pharma, 1950 Lake Park Drive SE, Smyrna, GA 30080, USA.
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PatientsLikeMe® Online Epilepsy Community: Patient characteristics and predictors of poor health-related quality of life. Epilepsy Behav 2016; 63:20-28. [PMID: 27544877 DOI: 10.1016/j.yebeh.2016.07.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/06/2016] [Accepted: 07/24/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The online PatientsLikeMe® Epilepsy Community allows patients with epilepsy to record, monitor, and share their demographic, disease, and treatment characteristics, providing valuable insights into patient perceptions and understanding of epilepsy. The objective of this retrospective analysis was to characterize the profile of users and their disease and identify factors predictive of poor health-related quality of life (HRQoL), while assessing the platform's potential in providing patient-reported data for research purposes. METHODS Data recorded (January 2010-November 2011) by Epilepsy Community members, with an epilepsy diagnosis and who reported >1 seizure, included the following: sociodemographic and disease characteristics, treatments, symptoms, side effects perceived as medication-related, seizure occurrence, and standardized questionnaires (Quality of Life in Epilepsy Inventory [QOLIE-31/P], EuroQoL 5-Dimensions Scale, 3 Levels [EQ-5D-3L], and Hospital Anxiety and Depression Scale [HADS]). Univariate and multivariate logistic regressions were conducted to identify predictors of poor HRQoL. RESULTS During the study period, the Epilepsy Community comprised 3073 patients, of whom 71.5% were female, had a mean age of 37.8years, and had a mean epilepsy duration of 17.7years. The most frequently reported moderate/severe symptoms (n=2135) included memory problems (60.2%), problems concentrating (53.8%), and fatigue (50.0%). Medication-related side effects (n=639) included somnolence (23.2%), fatigue (17.2%), and memory impairment (13.8%). The QOLIE-31/P scores (n=1121) were significantly worse in patients who experienced a recent seizure. For QOLIE-31/P, highly predictive factors for poor HRQoL included the following: mild/moderate problems concentrating, depression, memory problems, treatment side effects, occurrence of tonic-clonic seizures, and epilepsy duration ≤1year. For EQ-5D-3L, highly predictive factors for poor HRQoL included the following: pain, depression, and comorbidities. Patients on newer AEDs were less likely to report poor HRQoL (QOLIE-31/P). SIGNIFICANCE These findings move further towards supporting the feasibility and usefulness of collecting real-world, anonymized data recorded by patients online. The data provide insights into factors impacting HRQoL, suggesting that a holistic treatment approach beyond seizure control should be considered in epilepsy.
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Abstract
Anxiety disorders are frequent, though probably underdiagnosed, comorbidities in epilepsy. Epilepsy and anxiety may share common neurobiological correlates as shown in animal models and suggested by studies demonstrating anxiety disorders before the manifestation of epilepsy. Comorbid anxiety disorders have a major impact on the affected patients' quality of life and may increase the risk for suicidality. Successful treatment of the epilepsy may alleviate anxiety symptoms. Treatment of anxiety is based on selective serotonin reuptake inhibitors, benzodiazepines (although only as second-line choices), and psychotherapy. Specific AEDs (especially pregabalin) have been shown to have anxiolytic properties. This paper is aimed at reviewing anxiety disorders in patients with epilepsy discussing current scientific evidence about pathophysiology, clinical aspects, and treatment strategies.
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Affiliation(s)
- Christian Brandt
- Department of General Epileptology, Bethel Epilepsy Centre, Mara Hospital, Maraweg 21, D-33617 Bielefeld, Germany.
| | - Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals NHS Foundation Trust, London, UK; Institute of Medical and Biomedical Sciences, St George's University of London, London, UK.
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Li J, Wang X, Meng H, Zeng K, Quan F, Liu F. Systemic Family Therapy of Comorbidity of Anxiety and Depression with Epilepsy in Adolescents. Psychiatry Investig 2016; 13:305-10. [PMID: 27247596 PMCID: PMC4878964 DOI: 10.4306/pi.2016.13.3.305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/18/2015] [Accepted: 07/20/2015] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of this study was to find if systemic family therapy (SFT) does work in anxiety and depression with epilepsy in adolescents (ADAE). METHODS 104 adolescents with epilepsy, aged 13-20 years old, were included from December 2009 to December 2010, the enrolled patients were with anxiety [Hamilton Anxiety Scale (HAMA) score ≥14 points] or depression [Hamilton Depression Scale (HAMD) score ≥20 points]. The patients were randomly divided into the control group (n=52) treated with antiepileptic drugs (AED) and the intervention group (n=52) undergone Systemic Family Therapy (SFT) as well as AED. The AED improvements, anxiety and depression scores, Social Support Rating Scale (SSRS), Family Assessment Device (FAD) and scale of systemic family dynamics (SSFD) were observed after 3-month treatment. RESULTS The frequencies of epileptic seizures in intervention group was decreased much more significantly than the control group (4.22±3.54 times/month vs. 6.20±5.86 times/month, p=0.04); and the scores of anxiety (9.52±6.28 points vs. 13.48±8.47 points, p=0.01) and depression (13.86±9.17 points vs. 18.89±8.73 points, p=0.02) were significantly decreased than the control group; meanwhile, the family dynamics and family functions were significantly improved, and the social support was also increased (p<0.05). CONCLUSION SFT combined with AEDs had better efficacies than AEDs alone, not only the frequency of epileptic seizures was decreased, but also the patients' anxiety and depression were improved, and the family dynamics, family functions and social support were improved.
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Affiliation(s)
- Jing Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huaqing Meng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kebin Zeng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fengying Quan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fang Liu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Frequency of Restless Legs Syndrome in adults with epilepsy in Turkey. Epilepsy Behav 2016; 57:192-195. [PMID: 26970995 DOI: 10.1016/j.yebeh.2016.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Restless Legs Syndrome (RLS) is a common disorder characterized by an irresistible urge to move the legs particularly during rest in the evenings often leading to insomnia and daytime impairment. No prior studies estimate the prevalence of RLS in a diverse sample of adults with epilepsy using standard diagnostic criteria. MATERIAL AND METHOD A total of 225 patients with epilepsy (61.8% female; mean age 33.3 ± 12.3 years) seen in the epilepsy clinic of Çukurova University Neurology Department were included. Restless Legs Syndrome diagnosis was based on structured interviews using internationally accepted criteria. Demographic and epilepsy-related variables were obtained through medical record review. RESULTS The prevalence of RLS was 5.8% (n=13). Mean score on the International RLS Study Group rating scale for these subjects was 9.3 ± 3.6 (6-18). Ten (76.9%) patients with RLS scored in the mild range and the remainder in the moderate range of severity. Patients with RLS were not significantly different from others in terms of demographics, epilepsy classification or duration, treatment regimen (polytherapy vs. monotherapy), patient-reported sleep assessment, or relevant laboratory data. CONCLUSION The prevalence of RLS in adults with epilepsy was similar to that observed in the adult general Turkish population (3.18-5.2%), although we excluded subjects with conditions associated with RLS, rendering ours a conservative estimate. While preliminary, these findings support the need for future studies exploring RLS in epilepsy given the potential impact of untreated sleep disorders and sleep deprivation on seizures and quality of life in people with epilepsy.
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Ring A, Jacoby A, Baker GA, Marson A, Whitehead MM. Does the concept of resilience contribute to understanding good quality of life in the context of epilepsy? Epilepsy Behav 2016; 56:153-64. [PMID: 26895477 DOI: 10.1016/j.yebeh.2016.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/31/2015] [Accepted: 01/02/2016] [Indexed: 12/15/2022]
Abstract
A significant body of research highlights negative impacts of epilepsy for individual quality of life (QOL). Poor seizure control is frequently associated with reporting of poor QOL and good seizure control with good QOL; however, this is not a universal finding. Evidence suggests that some people enjoy good QOL despite ongoing seizures while others report poor QOL despite good seizure control. Understanding the factors that influence QOL for people with epilepsy and the processes via which such factors exert their influence is central to the development of interventions to support people with epilepsy to experience the best possible QOL. We present findings of a qualitative investigation exploring influences and processes on QOL for people with epilepsy. We describe the clinical, psychological, and social factors contributing to QOL. In particular, we focus on the value of the concept of resilience for understanding quality of life in epilepsy. Based on our analysis, we propose a model of resilience wherein four key component sets of factors interact to determine QOL. This model reflects the fluid nature of resilience that, we suggest, is subject to change based on shifts within the individual components and the interactions between them. The model offers a representation of the complex influences that act and interact to either mitigate or further compound the negative impacts of epilepsy on individual QOL.
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Affiliation(s)
- Adele Ring
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Ann Jacoby
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK.
| | - Gus A Baker
- Department of Molecular & Clinical Pharmacology, University of Liverpool, UK
| | - Anthony Marson
- Department of Molecular & Clinical Pharmacology, University of Liverpool, UK
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Kotwas I, McGonigal A, Trebuchon A, Bastien-Toniazzo M, Nagai Y, Bartolomei F, Micoulaud-Franchi JA. Self-control of epileptic seizures by nonpharmacological strategies. Epilepsy Behav 2016; 55:157-64. [PMID: 26780213 DOI: 10.1016/j.yebeh.2015.12.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/12/2015] [Accepted: 12/14/2015] [Indexed: 02/04/2023]
Abstract
Despite the unpredictability of epileptic seizures, many patients report that they can anticipate seizure occurrence. Using certain alert symptoms (i.e., auras, prodromes, precipitant factors), patients can adopt behaviors to avoid injury during and after the seizure or may implement spontaneous cognitive and emotional strategies to try to control the seizure itself. From the patient's view point, potential means of enhancing seizure prediction and developing seizure control supports are seen as very important issues, especially when the epilepsy is drug-resistant. In this review, we first describe how some patients anticipate their seizures and whether this is effective in terms of seizure prediction. Secondly, we examine how these anticipatory elements might help patients to prevent or control their seizures and how the patient's neuropsychological profile, specifically parameters of perceived self-control (PSC) and locus of control (LOC), might impact these strategies and quality of life (QOL). Thirdly, we review the external supports that can help patients to better predict seizures. Finally, we look at nonpharmacological means of increasing perceived self-control and achieving potential reduction of seizure frequency (i.e., stress-based and arousal-based strategies). In the past few years, various approaches for detection and control of seizures have gained greater interest, but more research is needed to confirm a positive effect on seizure frequency as well as on QOL.
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Affiliation(s)
- Iliana Kotwas
- Laboratoire Parole et Langage UMR 7309, Aix-Marseille Université, Marseille, France
| | - Aileen McGonigal
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, Rue Saint-Pierre, 13005 Marseille, France; Unité Mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Agnès Trebuchon
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, Rue Saint-Pierre, 13005 Marseille, France; Unité Mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | | | - Yoko Nagai
- Psychiatry, Brighton and Sussex Medical School, University of Sussex, UK; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, UK
| | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, Rue Saint-Pierre, 13005 Marseille, France; Unité Mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Jean-Arthur Micoulaud-Franchi
- Service d'Explorations Fonctionnelles du Système Nerveux, Clinique du Sommeil, CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, Université de Bordeaux, France
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Roundtree HM, Simeone TA, Johnson C, Matthews SA, Samson KK, Simeone KA. Orexin Receptor Antagonism Improves Sleep and Reduces Seizures in Kcna1-null Mice. Sleep 2016. [PMID: 26446112 DOI: 10.5665/sleep.5444.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE Comorbid sleep disorders occur in approximately one-third of people with epilepsy. Seizures and sleep disorders have an interdependent relationship where the occurrence of one can exacerbate the other. Orexin, a wake-promoting neuropeptide, is associated with sleep disorder symptoms. Here, we tested the hypothesis that orexin dysregulation plays a role in the comorbid sleep disorder symptoms in the Kcna1-null mouse model of temporal lobe epilepsy. METHODS Rest-activity was assessed using infrared beam actigraphy. Sleep architecture and seizures were assessed using continuous video-electroencephalography-electromyography recordings in Kcna1-null mice treated with vehicle or the dual orexin receptor antagonist, almorexant (100 mg/kg, intraperitoneally). Orexin levels in the lateral hypothalamus/perifornical region (LH/P) and hypothalamic pathology were assessed with immunohistochemistry and oxygen polarography. RESULTS Kcna1-null mice have increased latency to rapid eye movement (REM) sleep onset, sleep fragmentation, and number of wake epochs. The numbers of REM and non-REM (NREM) sleep epochs are significantly reduced in Kcna1-null mice. Severe seizures propagate to the wake-promoting LH/P where injury is apparent (indicated by astrogliosis, blood-brain barrier permeability, and impaired mitochondrial function). The number of orexin-positive neurons is increased in the LH/P compared to wild-type LH/P. Treatment with a dual orexin receptor antagonist significantly increases the number and duration of NREM sleep epochs and reduces the latency to REM sleep onset. Further, almorexant treatment reduces the incidence of severe seizures and overall seizure burden. Interestingly, we report a significant positive correlation between latency to REM onset and seizure burden in Kcna1-null mice. CONCLUSION Dual orexin receptor antagonists may be an effective sleeping aid in epilepsy, and warrants further study on their somnogenic and ant-seizure effects in other epilepsy models.
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Affiliation(s)
| | - Timothy A Simeone
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | - Chaz Johnson
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | | | - Kaeli K Samson
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | - Kristina A Simeone
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
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Roundtree HM, Simeone TA, Johnson C, Matthews SA, Samson KK, Simeone KA. Orexin Receptor Antagonism Improves Sleep and Reduces Seizures in Kcna1-null Mice. Sleep 2016; 39:357-68. [PMID: 26446112 DOI: 10.5665/sleep.5444] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/28/2015] [Indexed: 01/14/2023] Open
Abstract
STUDY OBJECTIVE Comorbid sleep disorders occur in approximately one-third of people with epilepsy. Seizures and sleep disorders have an interdependent relationship where the occurrence of one can exacerbate the other. Orexin, a wake-promoting neuropeptide, is associated with sleep disorder symptoms. Here, we tested the hypothesis that orexin dysregulation plays a role in the comorbid sleep disorder symptoms in the Kcna1-null mouse model of temporal lobe epilepsy. METHODS Rest-activity was assessed using infrared beam actigraphy. Sleep architecture and seizures were assessed using continuous video-electroencephalography-electromyography recordings in Kcna1-null mice treated with vehicle or the dual orexin receptor antagonist, almorexant (100 mg/kg, intraperitoneally). Orexin levels in the lateral hypothalamus/perifornical region (LH/P) and hypothalamic pathology were assessed with immunohistochemistry and oxygen polarography. RESULTS Kcna1-null mice have increased latency to rapid eye movement (REM) sleep onset, sleep fragmentation, and number of wake epochs. The numbers of REM and non-REM (NREM) sleep epochs are significantly reduced in Kcna1-null mice. Severe seizures propagate to the wake-promoting LH/P where injury is apparent (indicated by astrogliosis, blood-brain barrier permeability, and impaired mitochondrial function). The number of orexin-positive neurons is increased in the LH/P compared to wild-type LH/P. Treatment with a dual orexin receptor antagonist significantly increases the number and duration of NREM sleep epochs and reduces the latency to REM sleep onset. Further, almorexant treatment reduces the incidence of severe seizures and overall seizure burden. Interestingly, we report a significant positive correlation between latency to REM onset and seizure burden in Kcna1-null mice. CONCLUSION Dual orexin receptor antagonists may be an effective sleeping aid in epilepsy, and warrants further study on their somnogenic and ant-seizure effects in other epilepsy models.
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Affiliation(s)
| | - Timothy A Simeone
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | - Chaz Johnson
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | | | - Kaeli K Samson
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | - Kristina A Simeone
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
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Noël A, Quinette P, Hainselin M, Dayan J, Viader F, Desgranges B, Eustache F. The Still Enigmatic Syndrome of Transient Global Amnesia: Interactions Between Neurological and Psychopathological Factors. Neuropsychol Rev 2015; 25:125-33. [DOI: 10.1007/s11065-015-9284-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/30/2015] [Indexed: 11/25/2022]
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