Epilepsy & Behavior最新文献

Objective: Children with epilepsy may have significant mental health needs with detrimental impact on quality of life, and families often request support and intervention. This paper explores the change experienced by parents of young people with epilepsy and mental health difficulties receiving an integrated mental health intervention.

Methods: A qualitative study was conducted within a randomised controlled trial evaluating the Mental Health Intervention for Children with Epilepsy (MICE) psychological therapy in addition to usual care. Twenty-four families receiving the intervention were interviewed twice, at baseline and at six months, about their experience with their child's mental and physical health, and therapy. Transcripts were analysed inductively, idiographically and longitudinally using a combination of Interpretative Phenomenological Analysis (IPA) and Framework Analysis (FA). This combination allows us to begin our analysis with the detailed analysis of cases and then move to an appropriately higher level of generalization across the corpus.

Results: Analysis shows changes in how the parents report their experience of their child's difficulties between baseline and 6-month interviews. While parents tended to show some understanding of epilepsy and its effects on their child in the first interview, comparisons with the second interview show enhanced understanding along with improvements in their relationship with their child, and feelings about themselves as parents. These findings were particularly relevant for parents of children with autism spectrum disorders and/or intellectual disability.

Study limitations: Not all families were able to benefit equally from the therapy, with some declining to participate or being lost to follow up and mothers being more forthcoming than fathers to take part in the research. It would have been interesting to also interview families 12 months post-baseline to gain insight on the longer-term impacts of the intervention.

Conclusions: The qualitative findings presented here offer new insights into parental experiences of living with and attempting to assist a child with a complex condition. We would also hope the study will be helpful to researchers and clinicians working with a range of illnesses which impact families.

Objective: Anti-GAD65 antibodies have been identified in people with epilepsy for many years, but their pathophysiological relevance is still debated. Susceptibility to autoimmune disease has been associated with Human Leukocyte Antigen (HLA) subtypes. Therefore, this study aimed to determine if there are common HLA types in anti-GAD65 antibody associated epilepsy cases compared to epilepsy controls.

Methods: People with anti-GAD65 associated epilepsy and epilepsy controls were recruited from three Brisbane Hospitals from 2021 to 2023. Cases had high titre anti-GAD65 antibodies confirmed in CSF. High resolution genotyping for class I and II HLA to 3 fields was performed using next generation sequencing.

Results: 10 anti-GAD65 cases (8 with epilepsy and 2 with post-encephalitic epilepsy) and 45 controls were included. 6 cases (all female) had co-morbid autoimmune disease. A single class II association was found for DPB1*02 (Padj = 0.0109), which was identified in 7 of the cases (70 % vs 7.7 % controls). Significant association was preserved at high resolution for HLA-DPB1*02:02:01.

Conclusion: HLA association in anti-GAD65 antibody associated epilepsy might provide preliminary evidence to implicate an immune aetiology. DPB1*02 may confer a susceptibility to anti-GAD65 associated epilepsy and this class II association suggests a role for T cells in the pathophysiology.

Importance: Current epilepsy management protocols often depend on anti-seizure medication (ASM) trials and assessment of clinical response. This may delay the initiation of the ASM regimen that might optimally balance efficacy and tolerability for individual patients. Machine learning (ML) can offer a promising tool for efficiently predicting ASM response.

Objective: The objective of this review is to synthesize the available information about the effectiveness and limitations of ML models in predicting and classifying the response of patients with epilepsy to ASMs, and to assess the impact of various data inputs on prediction performance.

Evidence review: We conducted a comprehensive search of studies utilizing ML models for ASM response prediction using PubMed and Scopus up until November 2024.

Findings: The review included 37 studies. Various data types, including clinical information, brain MRI, EEG, and genetic data, are useful in predicting responses to ASMs. Tree-based ML algorithms and Support Vector Machines are the most used models. Reported results vary widely, with certain models achieving near-perfect accuracy and others performing similar to random classifiers. The review also highlights the limitations of this research field, especially concerning the quality and quantity of data.

Conclusions and relevance: The findings indicate that while ML models show great promise in predicting ASM responses in epilepsy, further research is required to refine these models for practical clinical application. The review underscores both the potential of ML in advancing precision medicine in epilepsy management and the need for continued research to improve prediction accuracy.

In epilepsy, there may be impairment of psychosocial aspects, including restrictions for the license to drive vehicles.

Objective: To evaluate the license to drive a vehicle in patients with epilepsy according to Brazilian legislation and to relate it to demographic and clinical variables.

Methodology: The license-to-drive vehicle rate was related to the demographic and clinical data of 305 patients with epilepsy.

Results: The mean age was 49.2 years, with 176 females, the mean education was six years, and structural epilepsy occurred in 203 patients. The license to drive vehicles occurred in 35 (11.5 %) patients. In the multiple logistic regression analysis, with stepwise variable selection criteria, it was observed that the variables that together best predict the possession of a driving license are education (p-value = 0.012; OR = 1.15 (1.03, 1.29)), sex (p-value = 0.001; OR = 4.05 (1.80, 9.68)), marital status (p-value = 0.022; OR = 2.67 (1.18, 6.41)), neurological examination (p-value = 0.029; OR = 3.62 (1.25, 13.22)) and number of antiseizure medication (ASM) in use (p-value = 0.019; OR = 3.04 (1.26, 8.28)). The license did not comply with Brazilian legislation in 21 (60 %) patients. In nine patients, the practice violated the law due to the type of vehicle, and in 12 patients, due to the maintenance of seizures in the last year. Patients with non-legal aspects of the license were older, had less education, were male, and had a spouse.

Conclusion: In patients with epilepsy, the rate of license to drive vehicles was low, and it was associated with higher schooling, males, having a spouse, having no alterations in the neurological examination, and the use of a single ASM. The non-compliance with current legislation was high, suggesting a lack of information or denial of the disease.

Introduction: Alexithymia, characterized by difficulty identifying and expressing emotions, is commonly observed in individuals with psychiatric and neurological disorders. However, its prevalence in patients with epilepsy (PWE), particularly in those with drug-resistant epilepsy (DRE), remains under-researched. This study investigates the prevalence of alexithymia in patients with DRE and explores its associated factors.

Methods: We conducted a retrospective observational study of 118 adult patients with focal DRE undergoing presurgical evaluation at Bordeaux University Hospital. Alexithymia was assessed using the Toronto Alexithymia Scale-20 (TAS-20), while psychiatric symptoms were evaluated with validated scales. Data on demographic characteristics, epilepsy duration, seizure frequency, antiepileptic drug use, and localization of the epileptogenic zone (EZ) were collected and analyzed using logistic regression models.

Results: Alexithymia was identified in 40.7 % of patients. Depression and anxiety were significantly associated with alexithymia (p < 0.01), whereas no correlation was observed between alexithymia and the localization or lateralization of the EZ.

Discussion: These findings suggest that alexithymia is prevalent among patients with DRE, with significant associations to depression and anxiety. The high prevalence of affective symptoms underscores the importance of early identification and intervention for alexithymia to improve outcomes in patients with DRE.

People with epilepsy face stigma that impacts numerous aspects of their daily lives. Although the stigma surrounding people with epilepsy has been extensively documented, the mechanisms underlying it-such as cultural stereotypes-remain to be explored. Cultural stereotypes are widely shared beliefs within a cultural context about attributes typically associated with members of a particular group. This study, conducted within French society, has two primary objectives: 1) to define the content of cultural stereotypes associated with people suffering from epilepsy and 2) to examine how familiarity and knowledge about epilepsy influence these stereotypes. To explore these stereotypes, a free association task was conducted across three cultural groups (n = 96): (1) the general population, with low familiarity and knowledge about epilepsy (n = 39); (2) healthcare professionals without epilepsy specialization, who have more familiarity and knowledge than the general population (n = 38); and (3) healthcare professionals specialized in epilepsy, who have the highest familiarity and knowledge of the three groups (n = 29). All participants held higher education qualifications to ensure a more homogeneous socio-cultural background across groups. Using the software program "IraMuTeQ", we analyzed the diversity of terms each group associated with "people with epilepsy." Additionally, we examined the valence and typicality of cultural stereotypes in each group. The results reveal that, regardless of familiarity and knowledge levels, cultural stereotypes linked to epilepsy are generally negative. Across the entire sample, the most prototypical associations with people with epilepsy included "madness," "possession," "tongue," and "intellectual deficiency." The general population shares some cultural stereotypes with non-specialized healthcare professionals (e.g., "photosensitivity"), while non-specialized professionals share other associations with specialized healthcare professionals (e.g., "intellectual deficiency" and "mental illness"). However, no overlap was found between the cultural stereotypes of the general population and those of healthcare professionals specialized in epilepsy. Stereotypes related to epilepsy appear to be less typical among healthcare professionals compared to the general population. This distinction between cultural stereotypes and personal beliefs is further discussed below. Considering cultural stereotypes may allow for more tailored and effective interventions to reduce epilepsy-related stigma by addressing specific socio-cultural groups. Further research within a cross-cultural approach is recommended to deepen these findings.

Purpose: Managing epilepsy may require using more than one anti-seizure medication (ASM). While combination therapy may help, risks, including psychiatric problems, are not fully explored in Africa. We examined the relationship between polytherapy and psychiatric comorbidities among attendees of an epilepsy community clinic.

Methods: We prospectively assessed individuals attending an outpatient clinic in Kilifi, Kenya, for patterns of ASM prescribing (mono- or polytherapy) and reviewed psychiatric diagnoses. We used the Psychosis Screening Questionnaire and the Patient Health Questionnaire Version 9 to assess for psychosis and depression, and the Child Behavior Checklist to assess for emotional and behavioural problems. We conducted a cross-sectional logistic regression analysis to determine factors associated with polytherapy and examine the impact of polytherapy and specific medication on psychiatric comorbidities.

Results: Of 3,016 attendees, most were on older ASM (99.7 %), with about a third (32.9 %) on polytherapy. The most commonly co-administered drugs were phenobarbital and carbamazepine (13.0 %). Children were less likely to be on multiple medications than adults, and there was no difference between the sexes. Polytherapy was associated with focal to bilateralised seizures (aOR 1.2 [95 % confidence interval:1.0-1.4]) and frequent seizures (aOR = 2.1 [1.5-2.9]). Combining drugs increased the likelihood of any psychiatric problems (aOR = 1.3 [1.0-1.8]), with polytherapy associated with depression (aOR = 2.9 [1.0-8.4]) and psychosis (aOR = 1.9 (1.0-3.6)).

Conclusion: Polytherapy, especially with older drugs, is associated with psychiatric comorbidities in this population. Resorting to polytherapy needs to be carefully considered. Prioritizing research into the long-term effects of ASM on psychiatric comorbidities is crucial for improving mental health outcomes in epilepsy, particularly in low-income settings.

The ethical use of laboratory animals requires that the benefits of an experimental study are carefully weighed against potential harm to the animals. In traumatic brain injury (TBI) research, ethical concerns are especially relevant to severe TBI, after which animals may experience suffering, depending on the implementation of refinement measures such as (1) postsurgical analgesia during the initial period following TBI and (2) humane endpoints. However, despite the frequent use of rodent models such as fluid percussion injury (FPI) and controlled cortical impact (CCI) in rats or mice, there is only one recent study that applied assessment of welfare to a severe TBI model, the FPI model in rats. In the present pilot study in a CCI mouse model of posttraumatic epilepsy, we assessed animal welfare by a brain injury-specific severity scoresheet. Furthermore, nest building was used as a sensitive indicator of health and welfare in laboratory mice. Sham mice that underwent craniotomy but not CCI were used for comparison. Craniotomy and CCI were performed under anesthesia with isoflurane, followed by 3 days of postsurgical analgesia with the opioid l-methadone. Mannitol was used to prevent the head pain caused by increased intracranial pressure. Using the TBI-specific scoresheet to describe and monitor potential distress in animals, moderately increased scores were determined in CCI mice only over the first 2 days after surgery, indicating that animal suffering in this model is transitory. Similarly, significantly impaired nest building was observed at 1 but not 7 days after CCI. We conclude that with effective postsurgical analgesia and mannitol behavioral recovery is rapid in mice after CCI.

Objective: To investigate associations between maternal epilepsy and pregnancy, delivery and neonatal outcomes.

Methods: A population-based retrospective cohort study was conducted using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database, between 2004-2014. Through logistic regression analysis, we compared associations between epilepsy and pregnancy-related outcomes while adjusting for demographic characteristics and comorbidities.

Results: Of 9,096,788 pregnancies, 25,044 were in pregnant women with epilepsy (PWWE). PWWE were more likely to be younger, white or black, have a lower income and to be insured through Medicare or Medicaid. Furthermore, PWWE were more likely to have been diagnosed with obesity, chronic hypertension, gestational diabetes, thyroid disease and HIV, and to have smoked tobacco during pregnancy or used illicit drugs. Pregnancy and delivery outcomes associated with epilepsy include pregnancy-induced hypertension(adjusted OR(aOR):1.26, 95 %CI:1.21-1.32), preeclampsia(aOR:1.33, 95 %CI:1.26-1.41), eclampsia(aOR:8.34, 95 %CI:7.14-9.74), superimposed preeclampsia/eclampsia(aOR:1.29, 95 %CI:1.14-1.47), placenta previa(aOR:1.24, 95 %CI:1.06-1.44), preterm delivery(aOR:1.27, 95 %CI:1.21-1.32), abruptio placenta(aOR:1.24, 95 %CI:1.12-1.36), chorioamnionitis(aOR:1.12, 95 %CI:1.02-1.23), cesarean section(aOR:1.29, 95 %CI:1.25-1.33), hysterectomy(aOR:1.79, 95 %CI:1.31-2.45), postpartum hemorrhage(aOR:1.12, 95 %CI:1.05-1.21), wound complications(aOR:1.38, 95 %CI:1.17-1.63), maternal death(aOR:3.42, 95 %CI:1.79-6.53), transfusion(aOR:1.67, 95 %CI:1.53-1.83), maternal infection(aOR:1.18, 95 % CI:1.09-1.28, p < 0.001), deep vein thrombosis(aOR:2.11, 95 %CI:1.43-3.10), pulmonary embolism(aOR:2.98, 95 %CI:1.87-4.76), venous thromboembolism(aOR:2.25, 95 %CI:1.65-3.08) and disseminated intravascular coagulation(aOR:1.48, 95 %CI:1.19-1.83). Epilepsy-linked neonatal complications include small for gestational age(aOR:1.52, 95 %CI:1.43-1.62), intrauterine fetal demise(aOR:1.20, 95 %CI:1.02-1.41) and congenital anomalies(aOR:2.76, 95 %CI:2.47-3.07).

Conclusions: PWWE have significantly higher risk of nearly every pregnancy, delivery and neonatal complication investigated, including maternal death and intrauterine fetal demise. PWWE should be considered high risk patients and be carefully followed during pregnancy.

Introduction: Epilepsy is a prevalent neurological condition globally, especially in Sub-Saharan Africa. In Ghana, it is one of the top five causes of premature death and disability, impacting children's neurological development and learning outcomes. Although 25% of epilepsy cases are preventable, many go undiagnosed and untreated. People with epilepsy face social stigma and rejection, hindering their ability to seek healthcare, employment, and social interactions, which worsens their self-esteem and social integration.

Purposes: The study aims to address the critical gaps in understanding and supporting people living with epilepsy (PLWE), through recording and analysing their experiences, and seeks to inform policy and practice, finally contributing to improve healthcare delivery, reduce stigma, and enhance support systems for PLWE.

Methods: A qualitative research design was employed for the study. Oral histories (OHs) were conducted with ten PLWE. These interviews encourage interviewees to focus on the life stories and experiences that mean the most to them and can be shared in their own words The interview questions were constructed in English and conducted in English, Twi, Ga and Dangme.

Results: The residents of Shai Osudoku and Ningo Prampram hold robust religious convictions and engage in profound spiritual practices as is the case throughout Ghana. When faced with health challenges, the PLWE and their caregivers often seek assistance from faith-based spiritual healers, including pastors or religious leaders, as their initial source of support and healing. These healers provide care by offering prayers, spiritual counselling, and incorporating various religious rituals into their healing practices. It was revealed that many PLWE, caregivers and community members perceived epilepsy differently. Some perceived it as a spiritual or demonic disease. Whilst others attributed to curse and disease of witches, idols, or gods. However, the healthcare practitioners perceived epilepsy as a medical condition. Also, it was found that individuals faced challenges, such as stigma and discrimination.

Conclusion: It is recommended that public education on epilepsy be intensified. Furthermore, there is the need to ensure that PLWE have access to improved healthcare to increase their quality of life.