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The objectives of this study were to estimate the prevalence of, and factors associated with, anxiety in epilepsy. We conducted a cross-sectional analysis using data from the Neurological Disease and Depression Study. The prevalence of anxiety and associated factors were assessed using descriptive statistics and logistic regression. Of the total sample (n = 250 patients), nearly 40.0% of participants had anxiety according to the Hospital Anxiety and Depression Scale. The most prevalent symptom of anxiety was 'worrying thoughts' (35.6%). After adjustment for age and sex, depression (odds ratio [ OR] = 8.97, 95% confidence interval [ CI] = 4.38-18.40), medication side effects ( OR = 1.79, 95% CI = 1.04-3.05), smoking ( OR = 4.35, 95% CI = 2.27-8.31), and illicit substance use ( OR = 2.42, 95% CI = 1.18-4.96) were significantly associated with higher odds of anxiety, whereas higher education ( OR = 0.47, 95% CI = 0.28-0.80) was associated with lower odds of anxiety. Furthermore, participants with anxiety reported more severe epilepsy, debilitating seizures, and overall lower quality of life. Evidence from our study reveals a high prevalence of anxiety in persons with epilepsy and that anxiety is associated with a variety of negative outcomes. These findings further emphasize the need for more studies to understand the impact of anxiety and its relationship with various sociodemographic and clinical factors. [ABSTRACT FROM AUTHOR]

Objectives To investigate prospectively the independent predictors of a minimum clinically important change ( MCIC) in quality of life ( QOL) after anterior temporal lobectomy ( ATL) for drug-resistant mesial temporal lobe epilepsy related to hippocampal sclerosis ( MTLE- HS) in Brazilian patients. Methods Multiple binary logistic regression analysis was performed to identify the clinical, demographic, radiologic, and electrophysiologic variables independently associated with MCIC in the Quality of Life in Epilepsy-31 Inventory ( QOLIE-31) overall score 1 year after ATL in 77 consecutive patients with unilateral MTLE- HS. Results The overall QOLIE-31 score and all its subscale scores increased significantly (p < 0.0001) 1 year after ATL. In the final logistic regression model, absence of presurgical diagnosis of depression (adjusted odds ratio [ OR] 4.4, 95% confidence interval [ CI] 1.1-16.1, p = 0.02) and a complete postoperative seizure control (adjusted OR 4.1, 95% CI 1.2-14.5, p = 0.03) were independently associated with improvement equal to or greater than the MCIC in QOL after ATL. The overall model accuracy for MCIC improvement in the QOL was 85.6%, with a 95.2% of sensitivity and 46.7% of specificity. Significance These results in Brazilian patients reinforce the external validation of previous findings in Canadian patients showing that presurgical depression and complete seizure control after surgery are independent predictors for meaningful improvement in QOL after ATL, and have implications for the surgical management of MTLE patients. [ABSTRACT FROM AUTHOR]

Objective Seizure-related disability is an important contributor to health-related quality of life in persons with epilepsy. Yet, there is little information on patient-centered reports of seizure-related disability, as most studies focus on specific constructs of health-related disability, rather than epilepsy. We investigated how patients rate their own disability and how these ratings correlate with various clinical and sociodemographic characteristics. Methods In a prospective cohort of 250 adults with epilepsy consecutively enrolled in the Neurological Disease and Depression Study (NEEDs), we obtained a broad range of clinical and patient-reported measures, including patients' ratings of seizure-related disability and epilepsy severity using self-completed, single-item, 7-point response global assessment scales. Spearman's correlation, multiple linear regression, and mediation analyses were used to examine the association between seizure-related disability scores and clinical and demographic characteristics of persons with epilepsy. Results The mean age and duration of epilepsy was 39.8 and 16.7 years, respectively. About 29.5% of the patients reported their seizures as 'not at all disabling,' whereas 5.8% of the patients reported them as 'extremely disabling.' Age, seizure freedom at 1 year, anxiety, and epilepsy severity were identified as statistically significant predictors of disability scores. The indirect effects of age and seizure freedom, attributable to mediation through epilepsy severity, accounted for 25.0% and 30.3% of the total effects of these determinants on seizure-related disability, respectively. Significance Measuring seizure-related disability has heuristic value and it has important correlates and mediators that can be targeted for intervention in practice. Addressing modifiable factors associated with disability (e.g., seizure freedom and anxiety) could have a significant impact on decreasing the burden of disability in people with epilepsy. [ABSTRACT FROM AUTHOR]

Objectives Health-related quality of life ( HRQOL) is an important indicator of well-being in patients with epilepsy. When assessing changes in HRQOL over time, some of the changes observed may be due to the patients' change in the internal standards, value, or meaning that they attribute to the HRQOL domain being measured, rather than actual change, a phenomenon known as response shift. Response shifts are increasingly recognized as an important explanation for the seemingly paradoxical or counterintuitive HRQOL results often observed in chronic conditions. We investigated the presence of changing values (reprioritization response shift) in data from a surgical randomized controlled trial of patients with temporal lobe epilepsy ( TLE). Methods Eighty patients with TLE, who were randomized to surgical and medical treatment, provided data on the epilepsy-specific 31-item Quality of life in Epilepsy (QOLIE-31) questionnaire at baseline and 1 year after randomization. Reprioritization response shift among the seven QOLIE-31 domains was assessed using changes in the relative importance weights derived from logistic regression and discriminant analysis. Results The relative importance analysis showed a statistically significant increase over time in the importance of social function, but a significant decrease in the relative importance of seizure worry. There were no significant changes in the relative importance of the remaining five domains in distinguishing between surgical and medical group over time. Significance Patients that receive surgical treatment are more likely to experience a decrease in the valuation of seizure worry and an increase in the value of social function as compared to patients who are medically treated. Changes in expectation about seizure freedom and social function may confound the assessment of longitudinal change on these outcomes, and highlight the importance of assessing response shift and the limitations of assessing HRQOL at a single point in time or without a control group. A PowerPoint slide summarizing this article is available for download in the Supporting Information section . [ABSTRACT FROM AUTHOR]

The objective of this study was to systematically review the literature to assess social outcomes after epilepsy surgery. A systematic literature search was conducted as part of a larger project on the development of an appropriateness and necessity rating tool to identify patients with focal epilepsy that may benefit from an epilepsy surgery evaluation. Studies were included if they reported postsurgical data on social outcomes (employment, driving, social relationships, marriage, education, financial status, behavior, and social interactions) and had a follow-up period of at least 24 months. Our search strategy yielded 5,061 studies. Sixty-five of these studies addressed social outcomes, but only 19 met all eligibility criteria. In adults, a significant improvement in full-time employment postsurgery was documented. The ability to drive was significantly increased after surgery and was dependent on seizure freedom. Patients generally perceived improved relationships, independence, and overall lifestyle postsurgery. Marital status generally remained unchanged when compared to controls, education improved modestly, and income/financial status changes depended on how it was assessed (e.g., income level vs. receipt of disability pension). In children, a study examining behavior showed improved social interactions in those who underwent surgery compared to controls. The results for other social outcome categories were more variable. Overall, the majority of studies reported improvement in social outcomes after surgery. However, prospective controlled observational studies using objective social outcome measures are necessary prior to making specific conclusions about the influence of surgery on social outcomes other than employment or driving status in all age groups, but particularly in children and the elderly. [ABSTRACT FROM AUTHOR]

The negative impact of epilepsy is disproportionate to its prevalence. Our objectives were to determine if health-related behaviors (HRBs) and health status differ between patients with epilepsy, migraine, or diabetes. The 2001–2005 Canadian Community Health Survey (N = 400,055) was used to explore health status and HRBs in patients with epilepsy, migraine, and diabetes and in the general population. Weighted estimates of association were produced as proportions with 95% confidence intervals (CIs). Logistic regression was used to explore the association between demographic variables and HRBs in epilepsy. The prevalence of active epilepsy, migraine, and diabetes was 0.6%, 8.4%, and 3.8%, respectively. Those with epilepsy and diabetes were more likely than migraineurs to perceive their health as poor and to be physically inactive. Obesity and comorbidities were more likely in all chronic conditions studied compared to the general population. Those with epilepsy or migraine were significantly more likely to smoke compared to the general population or to those with diabetes. Those with epilepsy were more likely to ever have consumed more than 12 alcoholic drinks per week. Health monitoring did not differ between groups. In the logistic regression analysis, epilepsy was associated with physical inactivity and lower alcohol consumption in the past 12 months compared to the general population. Our study demonstrated that those with epilepsy have a poorer pattern of HRBs and poorer health status compared to the general population. Screening for and managing comorbidities, and promoting exemplary HRBs, should improve overall health and quality-of-life in those with epilepsy. [ABSTRACT FROM AUTHOR]

The American Epilepsy Society and the Epilepsy Foundation jointly convened a task force to assess the state of knowledge about sudden unexplained death in epilepsy (SUDEP). The task force had five charges: (1) develop a position statement describing if, when, what, and how SUDEP should be discussed with patients and their families and caregivers; (2) design methods by which the medical and lay communities become aware of the risk of SUDEP; (3) recommend research directions in SUDEP; (4) explore steps that organizations can take to perform large-scale, prospective studies of SUDEP to identify risk factors; and (5) identify possible preventive strategies for SUDEP. Some of the major task force recommendations include convening a multidisciplinary workshop to refine current lines of investigation and to identify additional areas of research for mechanisms underlying SUDEP; performing a survey of patients and their families and caregivers to identify effective means of education that will enhance participation in SUDEP research; conducting a campaign aimed at patients, families, caregivers, coroners, and medical examiners that emphasizes the need for complete autopsy examinations for patients with suspected SUDEP; and securing infrastructure grants to fund a consortium of centers that will conduct prospective clinical and basic research studies to identify preventable risk factors and mechanisms underlying SUDEP. For now, the principal effort in preventing SUDEP should be prompt and optimal control of seizures, especially generalized convulsive seizures. [ABSTRACT FROM AUTHOR]

There is no consensus on whether or when to stop anticonvulsant drug treatment in patients after apparently successful epilepsy surgery. Although there are compelling reasons to consider antiepileptic drug (AED) discontinuation, there are relatively few data, and no class 1 data, to guide patient and physician decision-making on this topic. This debate lays out a conceptual framework for considering the issue of AED discontinuation, and reviews and critiques the avaialble data. The goal is to provide physicians with the best available data, a context in which to consider it, and a full understanding of its limitations. This article also highlights an area that is ripe for further prospective study. [ABSTRACT FROM AUTHOR]

: To identify the prevalence of injuries in people with epilepsy (PWE) in the general population. : We examined the prevalence of injuries obtained through the previously validated, door-to-door Canadian Community Health Survey (CHS) (n = 130,882). The 12-month weighted prevalence of injuries serious enough to limit normal activities was calculated for people with epilepsy and for the general population. Among those reporting injuries, variables of interest were compared in PWE and in the general population using risk ratios (RR) and their 95% confidence intervals (CI95). : The 12-month weighted prevalence of injuries was not different in PWE (14.9%) and in the general population (13.3%) (RR: 1.1, CI95: 0.90–1.3). Among individuals reporting injuries, the only significant differences were a lower frequency of sports-related injuries in PWE (RR: 0.7, CI95: 0.4–0.9), and a three-times higher frequency of hospitalization following injuries in PWE (RR: 3.0, CI95: 1.3–4.7). Orthopedic injuries were the most frequent type of injury in both groups, but the differences were not significant. Although there were some trends, no significant differences between PWE and the general population were seen with regard to place where injury occurred, mechanism of injury, and number of injuries. : The overall rate of injuries limiting activities did not differ between PWE and the general population. There was a higher rate of injury-related hospital admission in PWE, which could reflect that hospitalization is related to seizures and to comorbidities, and not injuries alone, or a more cautious attitude of clinicians towards injuries in PWE. [ABSTRACT FROM AUTHOR]

Evidence-based care (EBC) is an explicit approach to applying the best evidence to the care of individual patients. We outline the basic principles of EBC and apply them to various clinical questions pertaining to a patient presenting with a first seizure, providing a summary of the best available evidence for each question. Depending on the question at hand, the evidence derives from retrospective, prospective, and randomized controlled studies in children and adults. There is solid evidence that early seizure recurrence is reduced by early initiation of AEDs. A meta-analysis of six randomized trials revealed an average absolute risk reduction of 34% (95% CI 15–52) with AED therapy. However, the prognosis for the development of epilepsy is not altered by early intervention. EEG epileptiform abnormalities, family history of epilepsy, imaging lesions, and remote symptomatic seizures increase the risk of recurrence, and impact the risk–benefit ratio of treatment after a single event. In the end, clinicians must evaluate patients with a first unprovoked seizure on a case-by-case basis to determine the appropriateness of treatment with a given AED. [ABSTRACT FROM AUTHOR]

We assessed the impact of vagus nerve stimulation on a cohort of patients with intractable epilepsy. A 1-year prospective trial of vagus nerve stimulation for intractable epilepsy was done in 26 patients. Seizure frequency, anti-epileptic drugs, and quality of life were assessed using QOLIE-89, ELDQOL, and a Likert scale of impact of treatment. Seizures were reduced by more than 50% in 19% of the patients, by less than 50% in 46%, and were unchanged in 35% of them. Antiepileptic drugs were reduced in 43% of the patients. There was a significant improvement in the mean overall QOLIE-89 score and other measures of quality of life, but these did not correlate with changes in seizure frequency. Subjective improvement occurred in 84% of the patients. The quality of life improves in some patients following vagus nerve stimulation for intractable epilepsy. The favorable effects of this treatment may be attributable to additional factors besides seizure control which in this study was modest.Copyright © 2003 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The author discusses epilepsy, particularly relating to consciousness and loss of consciousness during epileptic seizures. Topics discussed include terminology used in academic and clinical discourse to discuss consciousness in epilepsy, the use of an individual descriptive approach when communicating about seizure, and linguistic concepts.

This article comments on a clinical study according to which an immediate antiepileptic drug (AED)regimen reduced short-term recurrence of seizures more than a deferred regimen. In a very diverse group of patients, with equally diverse risks for seizure recurrence, researchers compared early and deferred AED treatment after a first seizure or an early diagnosis of epilepsy. The more common occurrence of status epilepticus and deaths in the early-treatment group is unexpected and paradoxical however, the relatively infrequent occurrence precludes drawing valid statistical inferences. The possibility of somewhat sicker patients in the early-treatment group comes to mind, but chance alone could explain this finding.

Abstract: We systematically reviewed evidence-based determinants of health-related quality of life (QOL) in adults undergoing epilepsy surgery and assessed the effect of study methods. Medline, Embase, and the Cochrane library (1950–2008) were searched systematically. Two authors independently performed every step of the review. We obtained the proportion of studies reporting statistically significant positive or negative impact on QOL. Of 39 eligible studies, 32 assessed the impact of surgery on QOL and 29 (90.6%) found a significant positive effect. The most prevalent preoperative determinant was psychological function. Seizure freedom was the most prevalent postoperative determinant (80% of studies), followed by antiepileptic drug adverse events, employment status, and psychological function. Psychosocial (95%), physical (91%), and overall QOL (90%) domains improved most frequently, whereas role limitation (63%) and cognition (78%) improved least frequently. Methods, choice of instrument, and time of measurement influenced QOL outcomes and should be carefully chosen in future studies. [Copyright &y& Elsevier]

Abstract: Rationale:: Epilepsy is the most common serious neurological condition in the world, and an important cause of mortality and disability in developing countries. Because epidemiological and clinical characteristics of epilepsy vary by region, it is important to know the peculiarities of epilepsy in this area of the American continent. Methods:: We searched MEDLINE, IMBIOMED, and LILACS (The Latin-American and Caribbean biomedical database) to identify community-based studies reporting on the prevalence and incidence of epilepsy in Latin America. Studies were included if a definition of epilepsy was given, if data were obtained through standardized questionnaires and if raw population numbers were available for data confirmation. Results:: Thirty-three studies fulfilled eligibility criteria, 32 reported on prevalence and three on incidence of epilepsy. The median lifetime prevalence in all countries was 17.8 (range 6–43.2) per 1000 people, and the range for incidence was 77.7–190 per 100,000 people per year. There were no differences between rural and urban areas, by gender, age-group (children, adult, all ages), ascertainment method, or year of study. Conclusions:: Measuring the global burden of disease in Latin America requires adequate epidemiological information. This systematic review of epidemiological studies identifies higher prevalence and incidence rates of epilepsy in the general population of Latin America than in northern hemisphere countries. The remarkable heterogeneity found between and even within countries, could be explained by several factors, importantly, socioeconomic and methodological aspects. [Copyright &y& Elsevier]

Abstract: Objective: While there are well-established guidelines for optimum video-EEG monitoring (VEM), the process of reviewing VEM data varies amongst centres. In this study, we compared continuous with sampled reviewing of VEM data to assess whether their diagnostic yield differs. Methods: VEM data acquired from 50 consecutive patients (31 females) admitted for VEM were reviewed by two independent electroencephalographers, one using the continuous review method, and the other sampling the first five minutes of each hour together with events identified by push buttons and automated spike detection software. Overall agreement between reviewers was calculated using the Kappa statistic. Comparison between the total number of clinical events detected by the two methods was done by Pearson’s correlation coefficient. Results: A substantial number of events were missed using sampled review. Despite this, there was excellent agreement between the two methods on the final electro-clinical diagnosis for each patient (Kappa=0.89). Conclusion: In our laboratory, continuous VEM more comprehensively captured information of interest, but it did not substantially alter the final electro-clinical diagnosis. Significance: Sampled review of VEM data captures sufficient data to reliably make accurate clinical decisions. It may be considered as a more cost and labor efficient alternative to continuous review. [Copyright &y& Elsevier]

Abstract: The development and initial validity and reliability testing of a single-item, 7-point global rating scale designed for neurologists to assess the overall severity of epilepsy in children, the Global Assessment of Severity of Epilepsy (GASE) Scale, is described. The GASE Scale was quick and easy to use. Median epilepsy severity in the development sample was 3 (moderately severe), with a range from 1 (“not severe at all”) in 36 patients (26.9%) to 7 (“extremely severe”) in 7 patients (5.2%). Preliminary evidence of construct validity was found in support for our a priori predictions of associations between GASE scores and neurologists’ ratings of seven individual clinical aspects of epilepsy and in a cumulative R 2 for the GASE score of 81% using ratings of the clinical aspects of epilepsy. Weighted κ was 0.85 (95% CI: 0.79, 0.90) for inter-rater reliability and 0.90 (95% CI: 0.82, 0.98) and 0.95 (95% CI: 0.91, 0.98) for test–retest reliability for each of two raters. These promising initial results support continuation of the multistage process of testing the validity and reliability of the GASE Scale within various clinical contexts. [Copyright &y& Elsevier]

Abstract: In most chronic conditions, better health-related quality of life (HRQOL) is associated with higher socioeconomic status (SES) and ethnic majority status, with disadvantaged groups typically reporting lower HRQOL. In 163 children with intractable epilepsy, we evaluated the relationship between HRQOL and a broad spectrum of demographic variables (SES, parental education, gender, age, marital status, family size, and ethnic and linguistic status), in relation to known neurological and behavioral correlates of HRQOL. No demographic variable was found to be related to child HRQOL, except for marital status, where children from divorced/separated parents had lower HRQOL. However, marital status was not uniquely predictive of HRQOL when neurological and behavioral variables were taken into account. Exploratory analyses indicated that children of separated/divorced parents were more likely to have early epilepsy onset, lower adaptive/developmental levels, and worse seizure frequency, suggesting that severe epilepsy may be a risk factor for marital stress. In sum, contrary to research in other chronic conditions, sociodemographic variables in pediatric epilepsy were weak predictors of HRQOL in comparison to neurological and behavioral variables. The results are discussed with respect to epilepsy-specific determinants of HRQOL. [Copyright &y& Elsevier]