There is a significant correlation between fatigue in MS patients and disrupted sleep or abnormal sleep cycles.

Summary:Epilepsy is a chronic disorder that adversely affects social, vocational, and psychological functioning. Despite the variety and complexity of the negative clinical associations with epilepsy, depression is remarkable in prevalence and related adverse effects on health status. An estimated 30-50% of persons with refractory epilepsy have major depression, and depression has a stronger correlation than seizure rate with quality of life. Suicide is one of the leading causes of death in epilepsy. Available data indicate that depression may result from underlying brain dysfunction rather than social and vocational disability. Most patients with depression are not screened systematically for the diagnosis, and are subsequently not treated. Although the density of serotonin receptors is greatest in limbic brain regions commonly involved in human epilepsy, such as the mesial temporal and prefrontal areas, no prior randomized controlled trials have evaluated the efficacy of serotonin reuptake inhibitors for depression in epilepsy. Key Words: Epilepsy-Depression-PET-Quality of life-Seizures-Functional imaging.Epilepsy is a chronic disorder that has complex interactions with social, vocational, and psychological functioning. Although multiple epidemiological studies indicate that depression is a common comorbid condition in persons with epilepsy, the relative contributions of social and vocational disability compared to limbic system injury are not known (1). Many common syndromes, such as temporal lobe epilepsy and frontal lobe epilepsy, are associated with injury or dysfunction in brain regions implicated in the etiology of depression based on density of serotonin receptors. Despite the plausibility of the variable efficacy of serotonin-reuptake inhibitors related to limbic system responsiveness, few randomized controlled trials of the treatment of depression in epilepsy are published (2).The consequences of depression in persons with epilepsy have not been fully examined. Some clinical studies have suggested synergistic negative effects of epilepsy and depression on various aspects of health status, and suicide is one of the leading causes of death in epilepsy. Although depression appears to be highly prevalent in epilepsy and has significant consequences, available data indicate that most patients with depression are not screened or treated. This article reviews the available information regarding the etiologies of depression in epilepsy and current standards of care to offer areas for PREVALENCE OF DEPRESSION AND SUICIDE IN EPILEPSYThe prevalence of depression ranges from 20 to 55% in patients with recurrent seizures and from 3 to 9% in patients with well-controlled seizures, based on available epidemiological studies. In an inpatient sample in a video/EEG seizure monitoring unit, Boylan et al. (3) found that 50% were depressed, 19% had recent suicidal ideation, and only 17% were being treated with an antidepressant medication. Mendez et al. (4) used the Hamilton Depression Rating Scale in 175 consecutive p...

Background Interactive data visualization and dashboards can be an effective way to explore meaningful patterns in large clinical data sets and to inform quality improvement initiatives. However, these interactive dashboards may have usability issues that undermine their effectiveness. These usability issues can be attributed to mismatched mental models between the designers and the users. Unfortunately, very few evaluation studies in visual analytics have specifically examined such mismatches between these two groups. Objectives We aimed to evaluate the usability of an interactive surgical dashboard and to seek opportunities for improvement. We also aimed to provide empirical evidence to demonstrate the mismatched mental models between the designers and the users of the dashboard. Methods An interactive dashboard was developed in a large congenital heart center. This dashboard provides real-time, interactive access to clinical outcomes data for the surgical program. A mixed-method, two-phase study was conducted to collect user feedback. A group of designers (N = 3) and a purposeful sample of users (N = 12) were recruited. The qualitative data were analyzed thematically. The dashboards were compared using the System Usability Scale (SUS) and qualitative data. Results The participating users gave an average SUS score of 82.9 on the new dashboard and 63.5 on the existing dashboard (p = 0.006). The participants achieved high task accuracy when using the new dashboard. The qualitative analysis revealed three opportunities for improvement. The data analysis and triangulation provided empirical evidence to the mismatched mental models. Conclusion We conducted a mixed-method usability study on an interactive surgical dashboard and identified areas of improvements. Our study design can be an effective and efficient way to evaluate visual analytics systems in health care. We encourage researchers and practitioners to conduct user-centered evaluation and implement education plans to mitigate potential usability challenges and increase user satisfaction and adoption.

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Levetiracetam (LEV) reduces the incidence of seizures (1) and interictal epileptiform complexes (2) in patients with localization-related epilepsy. Here we report quantitative analyses of the effect of LEV on the incidence (spike-wave density, SWD) and duration of interictal spike-wave complexes (SWCs) in 10 patients with idiopathic generalized epilepsy (IGE). These patients underwent continuous video/EEG monitoring as part of their diagnostic evaluation, were determined to have IGE [diagnosed by history, interictal and ictal EEG findings, and normal magnetic resonance imaging (MRI)], and initiated LEV during the study. Because SWC incidence varies with time and sleep state, the long sampling by continuous EEG monitoring allowed statistical analyses of SWD and duration that could not be made with routine EEGs.Entire EEG records were not available for patients 1-3. Their responses to LEV were determined from the detailed video/EEG monitoring report and saved EEG samples. Patients 1 and 3 had frequent SWCs before LEV and no SWCs after LEV. Patient 2 had no response.Complete EEG records were available for patients 4-10. Each SWC was identified visually. The SWD was defined as the number of SWC in each 0.2-h time period divided by 0.2.Patient 4 was taking LEV at the start of the study and had SWD of 0 for the first 60 h of the record-

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ClinicalTrials.gov, https://clinicaltrials.gov, NCT02432573.