Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy

Boylan, Laura S.; Flint, Lynn A.; Labovitz, Daniel L.; Jackson, Stephanie; Starner, K.; Devinsky, Orrin

doi:10.1212/01.wnl.0000103282.62353.85

Cited by 558 publications

(368 citation statements)

References 25 publications

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“…There are evidences that psychological factors contribute 30 to 35% 8,23 or up to 50% 13,15,23,25 to the variation in QoL, as compared to values of about 20% for the clinical variables related to epilepsy. This strong connection between mood and the QoL instruments is well established in the context of other chronic diseases 10 .…”

Section: References Psychiatric Co-morbidities and Qolmentioning

confidence: 99%

“…Approximately 40% of the cases had no ES for more than one year. The majority of studies on QoL found in the literature evaluate patients with uncontrolled epilepsy, candidates for surgery, who frequently show an elevated occurrence of comorbidities and psychosocial difficulties, which could compromise their QoL 12,15,23,24 .…”

Section: Qol and The Socio-demographic And Clinical Aspectsmentioning

confidence: 99%

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Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity

Fonseca

Carvalho

2013

Arq. Neuro-Psiquiatr.

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Epileptic patients suffer from prejudice and limitations that can compromise their social integration, and hence present a greater incidence of psychiatric co-morbidities when compared to the general population and to individuals with other chronic diseases [1][2][3] .It is known that epilepsy has a great impact on the quality of life (QoL) [4][5][6] . However, how the socio-demographic variables, clinical aspects of epilepsy and the psychiatric co-morbidities act on the QoL has still not been completely elucidated, nor which specific domains would be more involved 5,7-10 .The performance of epileptic individuals is inferior in QoL evaluations and diverges in various aspects from that of individuals with other chronic diseases 5,11 or from that of the general population 6,7,12 .Among specific instruments for epilepsy, the Quality of Life in Epilepsy Inventory (QOLIE-31) 13 is one of the most used instruments, and was validated in 2007 for use in the Brazilian population 14 .The QoL scales possess a subjective construct and, if evaluated judiciously, can provide contributions for medical orientation and can influence health practices and policies.Study carried out at Faculdade de Medicina, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas SP, Brazil. ABSTRACTObjective: To study socio-demographic and clinical aspects, as well as psychiatric co-morbidity that influence the quality of life of adult epileptic patients. Methods: One hundred and thirty-two individuals diagnosed with epilepsy were evaluated from neurological/clinical and psychiatric points of view and by the Quality of Life in Epilepsy Inventory (QOLIE-31). Predictive factors for the QOLIE-31 scores were studied. Results: The regression analyses indicated the existence of psychiatric co-morbidity (total score, seizure worry, emotional well-being, energy/fatigue, social function and cognitive function) and a greater seizure frequency (total score, cognitive function and energy/fatigue) as predictive factors for lower scores in the total QOLIE-31 score and in various dimensions. Abnormalities in the neurological exam and polytherapy with anti-epileptic drugs were negative factors limited to one of the dimensions cognitive function and social function, respectively. Conclusion: The presence of psychiatric co-morbidity and a greater seizure frequency were the main factors influencing the quality of life in epileptic patients as evaluated by QOLIE-31.Key words: epilepsy, epileptic syndrome, quality of life. RESUMOObjetivo: Estudar os aspectos sociodemográficos, clínicos e comorbidades psiquiátricas que influenciam a qualidade de vida de pacientes adultos com epilepsia. Métodos: Cento e trinta e dois indivíduos com diagnóstico de epilepsia foram avaliados do ponto de vista clínico-neurológico e psiquiátrico e pelo Quality of Life in Epilepsy Inventory (QOLIE-31). Foram estudados os fatores preditores dos escores do QOLIE-31. Resultados: As análises de regressão indicaram a existência de comorbidade psiquiátrica (escore total, crises epilé...

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Section: References Psychiatric Co-morbidities and Qolmentioning

confidence: 99%

Section: Qol and The Socio-demographic And Clinical Aspectsmentioning

confidence: 99%

Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity

Fonseca

Carvalho

2013

Arq. Neuro-Psiquiatr.

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“…They significantly increase morbidity and mortality [2], being an important predictor of low quality of life (QoL) [3], treatmentemergent adverse events of antiepileptic drugs [4] and poor response to AED treatment [5]. Among psychosocial variables, several authors have pointed out the role of stigma, discrimination [6], locus of control, attributional style, adjustment to epilepsy [7], socioeconomic status, social support and parental overprotection [8].…”

Section: Introductionmentioning

confidence: 99%

Different attachment styles correlate with mood disorders in adults with epilepsy or migraine

Mula

Danquah-Boateng

Cock

et al. 2016

Epilepsy & Behavior

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Purpose: Interpersonal relationships are viewed as important contexts within which psychopathology emerges and persists or desists. Attachment theory describes the dynamics of longterm relationships between humans especially as in families and life-long friendships. The present study is aimed at investigating attachment styles in adult patients with epilepsy as compared to subjects with migraine and their potential correlates with a history of mood disorders.Methods: A consecutive sample of 219 adult outpatients with epilepsy (117) or migraine (102) has been assessed with the Attachment Style Questionnaire (ASQ). Results:Patients with epilepsy and a lifetime history of mood disorders presented elevated scores for Need for approval (p<0.001) and Preoccupation with relationships (p<0.001). Age correlated with Relationships as secondary (r= 0.322; p<0.001) and Need for approval (r=0.217; p=0.019) subscales while age at onset correlated only with Relationships as secondary (r=0.225; p=0.015). Seizure free patients presented lower scores for Need for approval (p=0.003). Patients with migraine and a lifetime history of mood disorders presented lower scores in Confidence (p=0.002) and higher scores in Discomfort with closeness (p=0.026).Conclusions: An anxious-preoccupied attachment correlates with mood disorders in epilepsy while an avoidant pattern in migraine. Our results bring further data on the role of psychological variables for mood disorders in epilepsy. Further studies will allow early identification of patients at risk and the development of preventive strategies.

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“…This co-morbidity is bi-directional; that is, patients with epilepsy are three to five times more likely to develop depression, and patients with active depression, a history of depression, or a family history of depression are nearly twice as likely to develop epilepsy, a risk which rises to 4.2-fold if they have a history of suicide attempt (Hesdorffer et al, 2006;Morgan et al, 2012). Depression has a more profound impact on the quality of life of individuals with epilepsy than seizure frequency or severity (Boylan et al, 2004;Cramer et al, 2003;Jehi et al, 2011;Johnson et al, 2004;Kanner, 2006;Pulsipher et al, 2006). Importantly, this co-morbidity is also highly detrimental to overall prognosis and outcome, as patients with both disorders exhibit higher rates of re-hospitalization and decreased success with treatment.…”

Section: Introductionmentioning

confidence: 99%

Seizure Susceptibility and Epileptogenesis in a Rat Model of Epilepsy and Depression Co-Morbidity

Epps

Tabb

Lin

et al. 2012

Neuropsychopharmacol

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Although a strong co-morbidity exists clinically between epilepsy and depression, the cause of this co-morbidity remains unknown, and a valid animal model is crucial for the identification of underlying mechanisms and the development of a screening tool for novel therapies. Although some rodent models of epilepsy have been reported to display behaviors relevant to affective disorders, the seizure susceptibility of animals prone to depression-like behavior has not been characterized. Toward this end, we assessed several forms of seizure sensitivity and epileptogenesis in rats selectively bred for vulnerability (Swim Lo-Active; SwLo) or resilience (Swim High-Active; SwHi) to depression-like phenotypes. The SwLo rats exhibit decreased motor activity in a swim test and other depression-like phenotypes, whereas the SwHi rats display increased motor activity in a swim test. SwLo rats exhibited a decreased latency to limbic motor seizures following acute pilocarpine administration in the absence of differences in pilocarpine pharmacokinetics, and also had a decreased threshold to tonic seizures induced by electroshock. Approximately half of the SwLo rats, but none of the SwHi rats, had spontaneous limbic motor seizures 5 weeks following pilocarpine-induced status epilepticus. While the number of stimulations required to achieve full amygdala and hippocampal electrical kindling were similar in the two rat lines, SwLo rats had a lower final hippocampal kindling threshold and more wet dog shakes during both amygdala and hippocampal kindling. Combined, these results indicate that SwLo rats are a model of epilepsy and depression co-morbidity that can be used for investigating underlying neurobiological and genetic mechanisms and screening novel therapeutics.

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Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy

Abstract: Treatment of depression may be inadequately prioritized in the management of intractable epilepsy.

Cited by 558 publications

References 25 publications

Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity

Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity

Different attachment styles correlate with mood disorders in adults with epilepsy or migraine

Seizure Susceptibility and Epileptogenesis in a Rat Model of Epilepsy and Depression Co-Morbidity

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